Pediatric Disease

Question 1

Atrial Septal Defect

Answer 1

• Persistent opening(s) across atrial septum
• Left-to-right shunt
• Acyanotic
• Includes “secundum atrial defect” (m/c) and “patent foramen ovale”
• Causes dilation of right heart chambers, overperfusion of pulmonary circulation
• Rare consequences include pulmonary vascular disease (>20y), CHF and failure to thrive (<1y)

Question 2

Patent Ductus Arteriosus

Answer 2

• Persistent opening between aortic arch and pulmonary arteries
• Systemic-to-pulmonary shunt
• Acyanotic
• Age >3 months = “persistent patency”
• Untreated may cause CHF, Infectious Endocarditis, pulmonary vascular disease, aneurysm formation, thromboembolism, calcification
• Respiratory distress

Question 3

Transposition of the Great Arteries

Answer 3

• Aorta comes from right ventricle, pulmonary artery from left ventricle
• Cyanotic
• Systemic venous return recirculated through RV to aorta, pulmonary venous return recirculated through LV to lungs
• Survival depends on patency of a right-to-left shunt (ventricular septal defect or patent ductus arteriosus)

Question 4

Ventricular Septal Defect

Answer 4

• Persistent opening(s) across ventricular septum
• Most common form of congenital heart defect
• Left-to-right shunt
• Acyanotic
• S/Sx: Murmurs, tachypnea, diaphoresis (with feeding), failure to thrive
• May eventually become right-to-left shunt with progressive cyanosis if pulmonary arteriolar thickness never decreases

Question 5

Bronchiolitis

Answer 5

• RSV infection of lower airways (m/c)
• Infants and toddlers < 2 years old (peak 3-6mos.)
• Obstructive airway pathology caused by inflammation
• Usually begins with mild URTI (fever, decreased appetite)
• Progresses to trouble exhaling, wheezy cough

Question 6

SIDS

Answer 6

• Unexpected death of infant under 1 year of age
• Triple-risk theory of SIDS: Infant’s underlying vulnerability + critical period in development + exogenous stressors
• Vulnerability = Genetic, inadequate response to hypoxemia or autonomic dysfunction
• Development = More likely to have apnea, sustained desaturations, poor ventilatory control
• Stressors = E.g Nicotine exposure or infection may reduce ventilation responses to hypercapnia and hypoxia by changing expression of serotonin receptors

Question 7

Down Syndrome

Answer 7

• Trisomy 21
• Developmental delay, intellectual disabilty, congenital heart deffects, GI abnormalities, thyroid dysfunction, insulin-dependent diabetes mellitus, increased risk of upper respiratory and ear infections, atlantoaxial instability, leukemia