Pedi Cards

Question 1

Thrills suggest what in peds

Answer 1

anatomic abnormality

Question 2

RV heave= what in peds

Answer 2

RV hypertension

Question 3

Differential pulses, weak in the lower extremities=

Answer 3

CoArc

Question 4

Bounding pulse= ???

Answer 4

bounding pulse

Question 5

Weak pule=

Answer 5

cardiogenic shock or CoArc

Question 6

Pulsus paradoxus (exaggerated SBP drop with inspiration)= ???

Answer 6

tamponade or severe asthma

Question 7

Pulsus alternans= ??

Answer 7

LV mechanical dysfunction

Question 8

What must you identify when listening to heart sounds in kids

Answer 8

S1 and S2

Question 9

Mid-systolic click= ???

Answer 9

MVP

Question 10

Loud S2= ??

Answer 10

pulmonary HTN

Question 11

Fixed, splits S2= ??

Answer 11

ASD, PS

Question 12

S3 gallop—>

Answer 12

may be due to cardiac dysfunction/volume overload

Question 13

Muffled heart sounds and/or a rub—>

Answer 13

pericardial effusion +/- tamponade

Question 14

What are the types of murmurs

Answer 14

• systolic ejection murmur= turbulence across a valve
• holosystolic murmur- turbulence begins w/ systole
• continuous murmur= pressure difference in systole and diastole

Question 15

Shunts present in the fetus and where they shunt blood

Answer 15

• ductus venosus: bypasses liver
• foramen ovale: R to L arterial shunt
• ductus arteriosus: R to L arterial shunt

Question 16

Holosystolic murmurs in babies have what

Answer 16

palpable thrill

Question 17

What happens when you clamp the umbilical cord

Answer 17

systemic vascular resistance is increased

Question 18

Ductus venousus connects what

Answer 18

umbilical vein to inferior vena cava, bypassing the liver

Question 19

Why does the ductus venosus close

Answer 19

due to fall in umbilical vein pressure

Question 20

What promotes lung expansion at birth

Answer 20

the alveoli filling with air instead of fluid

Question 21

Aeration of lungs at birth leads to what

Answer 21

• decreased pulmonary vein resistance

- increased pulmonary blood flow

Question 22

How does the foramen ovale close

Answer 22

proliferation of enothelial and fibrous tissue

Question 23

What does the ductus arteriosus do

Answer 23

protects the lungs against circulatory overload

Question 24

What aid in the closing of the ductus arteriosus

Answer 24

• increased O2 sat
• decreased pulmonary resistance
• decreased prostaglandin E2 levels

Question 25

Fetal structures that correspond to adult structures

Answer 25

foramen ovale--> fossa ovalis umbilical vein--> ligamentum teres ductus venosus--> ligamentum venousus ductus arteriosum--> ligamentum arteriosum

Question 26

Still's murmur?

Answer 26

vibratory, twangy, systolic murmur best hear at LSB and apex

Question 27

In what population is a Still's murmur most commonly heart

Answer 27

children 3-5 years

Question 28

When is a Still's murmur loudest

Answer 28

supine position *changes with position

Question 29

If a murmur has a thrill-->

Answer 29

NOT NORMAL

Question 30

What causes a Still's murmur

Answer 30

vibration of the great vessels and/or LVOT

Question 31

How does a pulmonary flow murmur change

Answer 31

- increases with supine position - decreases upright - increased by high output states

Question 32

Venous hum?

Answer 32

low pitched continious murmur often heard best in infraclavicular area, normal heart sound

Question 33

Positional changes with a venous hum

Answer 33

- loudest uprught | - diminishes with supine or compression of jugular vein

Question 34

Murmur red flags!

Answer 34

- diastolic murmur (venous hum ok) - loud murmurs, especially thrills - little or no effect with change in position - symptoms, especially cyanosis

Question 35

Ways to classify congenital heart disease

Answer 35

- acyantotic - cyanotic - obstructive lesions

Question 36

L---> R shunts, "acyanotic"

Answer 36

- VSD - PDA - ASD

Question 37

VSD

Answer 37

blood flows from high pressure left ventricle to low pressure right ventricle

Question 38

PDA

Answer 38

blood flows from high pressure aorta to low pressure pulmonary artery

Question 39

ASD

Answer 39

blood flows from high pressure left atrium to lower pressure right atrium

Question 40

VSD and PDA present how

Answer 40

in infant w/ heart failure, murmur and poor growth/ feeding *left heart enlargement

Question 41

ASD present how

Answer 41

in childhood w/ murmur or exercise intolerance, typically asx *right heart enlargement if severe

Question 42

Most common heart malformation

Answer 42

VSD

Question 43

Murmur in VSD

Answer 43

holosystolic murmur at lower left sternal border with a heave

Question 44

Clinical features of VSD

Answer 44

- failure to thrive - tachypnea - diaphoresis with feeding

Question 45

Where is an ASD mumur heard

Answer 45

pulmonary area *large shunts cause a diastolic flow murmur at left lower sternal bored

Question 46

Clinical features of PDA

Answer 46

- failure to thrive - diaphoresis with feeds - bounding pulse

Question 47

How can PDA be treated

Answer 47

indomethacin

Question 48

Cyanotic CHD is what kind of shunt

Answer 48

R--> left shunt

Question 49

Tetralogy of Fallot is what things

Answer 49

- rt ventricular outflow tract obstruction - VSD - overriding aorta - right ventricular hypertrophy

Question 50

Tetralogy of fallot on xray

Answer 50

boot shaped heart with concave pulmonary segment

Question 51

What is the murmur is tetralogy of fallot from

Answer 51

pulmonic stenosis, not from VSD

Question 52

Treatment of tetralogy of fallot

Answer 52

systemic pulmonary artery shunt in early infancy with later relief of the right ventricular outflow tract obstruction and closure of the ventricular defect

Question 53

Rheumatic fever is what

Answer 53

a post infectious connective tissue disease *follow GAS pharyngitis by several weeks

Question 54

Earliest and most common feature of rheumatic fever

Answer 54

painful migratory arthritis

Question 55

Presentation of acute rheumatic fever

Answer 55

- chorea - erythema marginatum - subcutaneous nodules