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Flashcards in PEDIATRIC DISORDERS Deck (104):
1

Auscultatory area of the aortic valve

Right upper sterna border (RUSB)

2

Auscultatory area of the pulmonic valve

Left upper sternal border (LUSB), 2nd intercostal space

3

Auscultatory area of the aortic or mitral valve

Apex (erbs point)

4

Auscultatory area of a ventricular septal defect or tricuspid valve

left lower sternal border (LLSB)

5

How does blood flow through the heart?

From the body, through the superior vena cava ->right atrium->tricuspid valve->right ventricle->pulmonic valve->pulmonary artery->lungs->pulmonary veins->left atrium->mitral valve->left ventricle->aortic valve-> body

6

What does S1 signify

mitral/ tricuspid (AV) valves closure

7

What does S2 signify

Aortic/ pulmonic (semilunar) valves closure

8

When is systole heard

Period between S1 and S2

9

When is diastole heard

Period between S2 and S1

10

What does S3 sound like and what does it mean

"Ken-tuck-y", increased fluid states

11

What does S4 sound like and what does it mean

"Ten-ne-ssee" and means stiff ventricular wall, or normal in athlete

12

What does Ventricular septal defect sound like?

thrill (think tetralogy of fallout)

13

What does an obstructive defect sound like?

ejection click due to turbulence, may be referred or radiate

14

Where is the blood shunting with acyanotic lesions?

left to right to shunting

15

Where is the blood shunting in cyanotic heart lesions?

Right to left shunting

16

The 3 types of heart defects

acyanotic, cyanotic, and obstructive

17

What kind of defect is this? 

Q image thumb

Transposition of the great arteries 

A image thumb
18

What kind of heart defect is this? 

Q image thumb

acyanotic defect, ventricular septal defect 

A image thumb
19

What kind of heart defect is this? 

Q image thumb

acyanotic defect, Patent ductus arteriosis

A image thumb
20

What kind of heart defect is this? 

Q image thumb

cyanotic defect, transposition of the great arteries 

A image thumb
21

What kind of heart defect is this? 

Q image thumb

obstructive lesions, aortic stenosis 

A image thumb
22

What kind of heart defect is this? 

Q image thumb

obtructive lesion, pulmonic stenosis 

A image thumb
23

What kind of heart defect is this? 

Q image thumb

obstructuve lesion, Coarctation of the aorta

A image thumb
24

What kind of heart defect is this?

Q image thumb

acyanotic defect, atrial septal defect 

25

What kind of heart defect is this? 

Q image thumb

cyanotic defect, tetralogy of fallot 

26

Where is an atrial septal defect murmer heard best? 

HEard best at the left upper sternal border (LUSB)

27

What does the ECG show for a Atrial Septal defect? 

Right ventricular hypertrophy (RVH)

28

WHat is the most common heart defect? 

Ventricular septal defect (VSD)

29

What kind of thrill will be felt  with a Ventricular septal defect (VSD) 

A holosystolic thrill, may be felt at the LLSB

30

What will the ECG show for a ventricular septal defect? 

What will X-ray show? 

Left ventricular hypertrophy (LVH) progressing to biventricular hypertrophy if large VSD

xray will show cardiomegaly, increased pulmonary vascular markings 

31

What is a common congential heart defect in premature infants? 

patent ductus arteriosis (PDA)

32

What does the murmer for Patent Ductus arteriosis sound like? 

Murmer is in the LUSB

Grade II to IV/VI holosystolic 

"machinery" sound

33

What does the murmer sound like for Transposition of the Great arteries? 

What might the xray look like? 

Grade II to V/VI systolic ejection murmer

xray might look like "egg on a tring" with cardiomargaly and increased pulmonary vascular markings

34

What are the 4 defects in tetralogy of fallot? 

Four defects: 

1) Large VSD

2)Pulmonary stenosis 

3) overiding aorta 

4)RVH 

35

What does the murmer sound like for tetralogy of fallot? 

Loud systolic ejection click at the middle and upper left sternal border (M-LUSB)

36

What will the ECG show is Tetralogy of fallot? 

Right axis deviation and right ventricular hypertrophy 

37

What does the x-ray show for tetralogy of fallot? 

boot-shaped heart, no cardiomegaly or pulmonary markings 

38

What are TET SPELLS

hypercynotic episodes. 

hypoxia- kids pull up knees or squat when SOB to increase peipheral vascular resistance and slow down blood return to the heart 

39

Where will the murmer be heard best in aortic stenosis? 

Systolic thrill at the right upper sternal border (RUSB), systolic ejection click present which does not vary with respirations

40

What does pulmonic stenosis murmer sound like 

Systolic, loudest at the LUSB, grade II to V/VI ejection click, intensity of click decreases with inspiration and inreases with expiration, thrill at the LUSB radiating to the back and sides

41

Corarctation fo the Aorta murmer 

Grade II to II/VI systolic ejection murmer with radiation to the left interscapular area

May have ejection click at the apex and RUSB if the bicuspid valve is involved 

42

xray findings for coarctation of the aorta

cardiomegaly, RIB NOTCHING DUE TO COLLATERAL CIRCULATION 

43

What kind of BP findings and pulse ox findings will you find in coarctation of the aorta 

BP in lower extremities will be lower than in upper extremitiesand 

44

What to do if suspected cadriac defect 

draw labs (CMP, CBC), CXR then refer 

45

Innocent murmers 

AKA functional, benign, or physiologic, not associated with symptoms, failure to thrive, or cyanosis. 

Occurs in >50% of children

Are low intensity systolic murmers (grades I-III)

May vary with positional changes (sit>standing)

No radiation to neck/back 

46

Most common inncocent murmer 

Stills murmer

Musical systolic murmer

HEard best between LLSB and apex 

Due to turbulense in the left ventricular outflow tract 

47

Venous hum

Innocent, Continuous humming murmer

RUSB

Hear best in the sitting position, disappears in the supine position

Also obliterated by turning head and or compressing neck ipsilaterally -same side 

48

Definition for hypertension 

A persistent elevation of average systolic/ diastolic BP >95th percentile with measurements obtained on at least 3 separate occassions per published tables for age and sex. In children, is secondary 

49

labs/ diagnostics for HTN 

CXR (PA and lateral) 

plasma aldosterone level to rule out aldosteronism

morning and evening cortisol level to rule out cushings

UA, BMP, CBC, cholesterol, and triglycerides

ECG for dysrhythmias, BBB or LVH

50

Rhematic fever/ heart disease definition and cause 

A post infectious inflammatory disease that can affect the heart, joints and central nervous system

Rheumatic fever followsa group A strep infection of the upper respiratory tract and is most common in ages 6-15

51

Jone's criteria 

diagnosis of an initial attack for rheumatic fever plus 2 major or 1 major and 2 minor Jone's criteria

MAJOR CRITERIA:

Carditis, polyathritis, chorea (involuntary jerky movements) erythema marginatum, subcutaneous nodules

MINOR CRITERIA:

Arthralgia without objective inflammation, fever >102.2F, elevated ESR and CRP, prolonged PR interval on ECG with evidence of a group A Bhemolytic streptococcus infection 

52

Kawasaki disease definition 

acute febrile syndrome causing vasculitis 

53

Diagnositic criteria for kawasaki disease 

The patient MUST have a fever as well as 4 of the following criteria: 

1)Fever for >5 days 

2)Bilateral conjunctival injections without exudate

3) Polymorphous rash (urticarial or pruitic)

4)Inflammatory changes of the lips or oral cavity (strawberry tongue)

5)Changes in extremities (eg erythema, edema, ect)

6)cervical lymphadenopathy 

 

54

Management for Kawasaki disease 

Immediate referral to cardiovascular specialist, high dose ASA therapy 

55

Labs/diagnositics for kawasoki disease 

CBC, ESR, postivie c reactive protein, ECG changes- prolonged PR or QT interval 

56

Mild dehydration in pediatrics- BP, pulse, CAP refill, SKin turgor, fontanel, urine 

Mild is 3%-5%

BP-normal

Pulse-normal

CAP refill- WNL

SKin turgor- normal

Fontanel- NOrmal 

Urine- slightly decreased 

57

Moderate dehydration in pediatrics- BP, pulse, CAP refill, skin turgor, fontanel, urine

Moderate (6%-9%)

BP- normal

pulse- increased 

CAP refill- WNL

skin turgor- decreased 

fontanel- sunken in (slightly)

urine- <1ml/kg/hour 

58

heart valve affected by rheumatic fever 

mitral valve 

59

Severe dehydration in pediatrics- BP, pulse, CAP refill, skin turgor, fontanel, urine 

Severe(>10%)

BP- normal or decreased

Pulse- Severe, decreased

CAP refill- prolonged(>3 seconds)

Skin turgor- decreased 

Fontanel- sunken

Urine- <1m/kg/hr

60

Heart defect with DiGeourge syndrome syndrome 

Aortic arch abnormalities 

61

Heart defects with trisomies 

Trisomy 18/ edwards

Trisomy XXI/down syndrome-Atrioventricular septal defects, VSD

62

Heart defect with marfans syndrome

Aortic regurgitation, mitral valve prolapse (leads to anurysm)

63

heart defect with Turner syndrome 

Coarctation of the aorta, bicuspid aortic valve 

64

When to work up gastroenteritis 

None indicated unless symptoms persist more than 72 hours or bloody stool present 

65

Oral rehydration therapy for moderate dehydration 

50ml/hr

66

Oral rehydration for severe dehydration

100ml/hr 

67

When to consider antibiotic therapy for gastroenteritis and what antibiotic 

consider when more than 8-10 stools daily. 

trimethroprim/ sulfamethoxazole (TMP/SMZ), bactrim 

68

definition of GERD 

A condition in which gastric contents pass into the esophagus form the stomach though the lower esophageal sphincter (LES)

69

The three classes of GERD 

Physiological: Infrequent, episodix

Functional: Painless, effortless vomitting with no physical sequelae

Pathological: frequent vomiting with alteration in physical functioning such as FTT and aspiration PNA (worrisome)

70

71

When will GERD resolve for premature and low birth weight 

typucally by 18months 

72

first and second line tx for pediatric GERD 

first line- Histamine H2 receptor anatgonist to inhibit gastric scid secretion caused by histamine (ranitidine, famotidine)

Second line- proton pump inhibtor (PPIs) to block gastric acid secretion caused by histamine, acetylcholine or gastrin (omeprazole)

73

Definition of pyloric stenosis 

Obstruction resulting from the thickening of the cicular muscle of the pylorus

74

s/sx of pyloric stenosis

3 weeks to 4 months old 

Projectile non-bilious vomiting after eating 

Hungry after vomiting 

poor weight gain or weight loss

Eventual dehydration

Visible peristaltic waves 

Palpable mass (pyloric olive) after vomiting 

 

75

Diagnostics for pyloric stenosis

abdominal US, if nondiagnostic, do upper GI imaging, will show a "string sign" or a narrowed pyloric channel 

76

Definition of intussusception 

Acute prolapse (telescoping) of one part of the intestine into another adjacent segment of the intestine

77

Signs/symptoms of intussusception 

Previously healthy infant develops acute colicky pain, bilious vs non-bilious vomiting, progressive lethargy, currant jelly stool: late presentation, sausage shaped mass in the right upper quadrant, progressive distention/tenderness, if not reduced, perforation and shock may occur 

78

Diagnostic for intussuseption

U/S or radiograph, barium enema

79

S/SX of hirschsprung's disease (aganglionic megacolon)

Failure to pass meconium, BILIOUS vomiting, jaundice, infrequent, explosive bowel movements, progressive abdominal distention, tight anal sphincter with empty rectum, failure to thrive, malnutrition 

80

S/SX of appendicitis 

Begins with vague, colicky umbilical pain. After several hours pain shifts to right lower quadrants of the abdomen (RLQ), psoas sign, rebound tenderness, obtrurator sign, McBurneys point tenderness, pain worsens and localizes with cough, nausea with 1-2 episodes of vomiting, sense of constipation, infrequently diarrhea, fever 

81

What are the 2 confirmtatory tests for appendicitis? 

Psoas sign and obturator sign 

82

Psoas sign

confirmatory test for appendicits, Pain with right thigh extension 

83

obturator sign

confirmatory test for appendicitis, pain with internal rotation of the right thigh 

84

McBurneys point tenderness 

One-third the distance from the anterior superior iliac spine to the umbilicus 

85

Labs/ Diagnostics for appendicitis 

CT is diagnositc, WBC 10-20, ESR elevated, US 

86

Malabsorption definition 

Impaired intestinal absorption of essential nutrients and electrolytes caused by enzymatic deficiencies (eg cycstic fibrosis), celiac disease (sprue), gluten intolerance, infectious agents, and abnormalities of the intestinal mucosa 

87

S/Sx of malabsoption 

FTT

Severe, chronic diarrhea

Bulky, foul stool (steatorrhea) CYSTIC FIBROSIS

Vomitting

Abdominal pain

Protuberant abdomen 

Associated with vitmain deficiency of malabroption: pallor, fatigue, hair and derm abnormalities, cheilosis, peripheral neuropathy 

88

labs/ diagnositics for malabsorption 

stool (culture, hemoccult, O&P)

Serum Ca, Phos, alk phos, total protein, ferritin, folate, and LFTS

Bone age

Lactose and sucrose breath hydrogen testing (Hpylori)

Sweat chloride test if clinical suspicion of cystic fibrosis

89

cystic fibrosis test 

Sweat chloride 

90

Celiac disease diet modification 

No wheat, oats, rye, barley 

91

Cystic fibrosis dietary modifications 

pancreatic enzyme replacement: Lipase, amylase, tripsan

Fat soluble vitamins: A, D, E, K

92

When it comes to hepatitis, most children are _____, so infections frequently go unnoticed 

Anicteric 

93

pre-icteric state of hepatitis S/SX

fatigue, malaise, anorexia, n/v, headache, aversion to second-hand smoke and alcohol odors 

94

Icteric state of hepatitis s/sx 

weight loss, jaundice, pruritus, right upper quadrant abdominal pain (RUQ), clay colored stool, dark urine 

95

AST and ALT____ prior to onset of jaundice and will ____ after jaundice presents 

rise, fall

96

Neuroblastoma definition 

Tumor arising form neural tissue, frequently from the adrenal gland and can spread to bone marrow, liver, lymph nodes, skin, and orbits of the eyes 

97

Serology for Acute Hepatitis A

Anti-HAV, IgM

98

Serology for recovered hepatitis A 

anti-HAV, IgG

99

Active hepatitis B serology 

HBsAg, HBeAg, Anti-HBc, IgM

100

chronic hepatitis B serology 

HBsAg, Anti-HBc, Anti-Hbe, IgM, IgG

101

Recovered hepatitis B (also vaccinated and seroconverted) 

Anti-HBc, Anti-HBsAg, IgG +

102

Serology for both acute and chronic hepatitis C 

Anti-HCV, HCV RNA 

103

how high indicated fever in an infant? 

rectal temp of 100.4

104

what temp can fever convulsions occur? 

101F, but more how quickley the fever rises not how high it goes