Pediatrics Flashcards
(117 cards)
1
Q
Workup for constitutional growth delay
A
IGF1, thyroid, kidney, wrist XR
2
Q
Laryngomalacia
A
Floppy larynx, presents with squeaking stridor
No need for treatment unless severe/resulting in breathing difficulty
3
Q
Normal weight gain at two weeks
A
1 ounce per day, 25-30g per day
4
Q
Three most common causes of ear infections/sinus infeections/PNA in children
A
Strep pneumoniae
H. Flu
Moraxella catarrhalis
5
Q
First line treatment for ear infections
A
Amoxicillin (90mg/kg) or cephalexin
Pink, bubblegum flavor
-If using to treat strep throat, dose is 50mg/kg
6
Q
First line treatment for bacterial sinus infection
A
Augment (amoxicillin + clavulonic acid) or ceftanir
-ceftanir is better tasting
7
Q
Treatment for croup
A
Dexamethasone 0.6mg/kg for one dose, oral of injectable because has no flavor
-prednisolone if the above is not available
8
Q
Symptoms of pediatric sinus infection
A
ALWAYS has cough
- Cold-like sxs that fail to get better after 10 days
- Cold-like sxs that get better for a day or two and then get way worse
- Typical adult sinusitis symptoms (HA, sinus tenderness, drainage)
9
Q
What are characteristics of bad lymph nodes?
A
Firm, nonmobile, nontender, and subclavicular are the worst
10
Q
Treatment of colds
A
NO COUGH MEDICINE UNDER THE AGE OF SIX! Only treat the fever if it’s bothersome
11
Q
Failure to thrive
A
<2% and decreased velocity of weight gain, disproportionate to length
12
Q
Familial short stature
A
Parent’s height is short and so is patient’s adult height but young growth pattern is normal
13
Q
Constitutional growth delay
A
Parental height is normal, patient has delayed puberty and slow growth
14
Q
Anorexia
A
Short stature from poor nutrition
15
Q
Turner’s syndrome
A
- Mild growth retardation in utero
- Slow growth during infancy
- Delayed onset of childhood component of growth
- Slow growth during childhood
16
Q
Cause of anemia in infants
A
Can be Vitamin A deficiency
17
Q
Milestone categories
A
Communication
Gross motor
Fine motor
Other (object permanence, etc)
18
Q
Appointment schedule
A
Newborn, 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 14 months, 16 months, 18 months, 2 yeras, 2.5 years, every year
19
Q
Hip exam
A
Ortolani, Barlow & Galeazzi maneuvers
20
Q
Encopresis
A
Severe constipation that causes stretching of the bowel wall and hardening of old stool - new stool gets liquefied and slides around stool - presents as leakage in the underwear
21
Q
Red flags of HA
A
worst headache of life thunderclap headache woke from sleep LOC with an injury early morning onset with vomiting
22
Q
Exam for headache
A
Full neuro, including:
- ophthalmoscope to look for papilledema
- cranial bruits on head and orbits
- visual fields
- rapid alternating hand movements
- back for scoliosis
23
Q
Treatment for conjunctivitis
A
Fluoroquinolones, such as oflaxacin
24
Q
Systematic approach for differential diagnoses
A
Vascular Infectious Neoplasm Drugs Inflammatory/idiopathic Congenital Autoimmune Trauma Endocrine/metabolic
25
When to do post-partum depression screening
2 months
4 months
6 months
26
Pediatric physical exam
Ears
Eye exam if not seeing eye doctor (light reflex, EOM, visual fields). Starting at age 5-6, do fundoscopic if no eye doctor
Quick neuro (eyes shut and open, cheek puff, upper extremity strength)
Neck
Heart sitting and lying down
Lung
Belly
GU (at age 5-6 for girls, ask about hair. always check testes for boys)
Leg mobility lying down
Sitting up, check knee reflexes
Standing up: squat, duck walk, toe walk, heel, walk, scoliosis check
27
1 month milestones
Lift head, track with eyes, coo, recognizes parents
28
6 month milestones
Sit up, raking grasp, babbles, stranger anxiety
29
9 month milestones
Walk with assistance, 3 finger grasp, maybe mama/dada?, wave bye/patacake
30
12 month milestones
Walk without assistance, pincer grasp, imitate parents, mama/dada
31
24 month milestones
2 steps, 2 word sentences, 2 step commands, 6 blocks
32
3 year milestones
Tricycle, 3 word sentences, brush teeth, circle, know colors and maybe 123
33
4 year milestones
Hops, copy cross, plays with kids
34
What is paronychia?
Bacterial infection along lateral nail fold
35
What is herpetic whitlow?
Viral infection of HSV of the finger. Bimodal: <10years, 20-30 years, vesicles that appear purulent
36
Treatment of depression in children
Fluoxetine
37
Bronchopulmonary dysplasis
Decreased surfactant, increased oxygen demands
XR shows ground glass
Tx: surfactant postnatal and steroids prenatal
Becomes diffuse parenchymal lung disease
38
Retinopathy of prematurity
Due to premature, increased O2 demands
Dx: eye exam
Tx: Laser
Can lead to glaucoma
39
Intraventricular hemorrhage
Babies susceptible given highly vascular ventricles
Be careful of blood pressures!
Premie, have increased ICP
Dx: Cranial doppler
Tx: Decrease ICP with VP shunts and drains
Can lead to seizure, mental retardation
40
Necrotizing enterocolitis
```
Dead gut
Premie with bloody bowel movement
XR: pneumotosis intestinal (air in the wall of the gut)
Tx: NPO, IV antibiotics, TPN
Need surgery
```
41
Failure to pass meconium
Nothing comes out within 48 hours!
1. Imperforate anus- no hole. Get cross table XR (determine severity). Mild: fix now. Severe: colostomy now, fix later.
- Vertebral anomaly (US sacral)
- Imperforate anus
- Cardiac issues (echo)
- Tracheoesophageal fistula
- Esophageal atresia (catheter with XR)
- Renal (voiding cystourethrogram)
- Limb (XR of the wrist)
2. Meconium ileus: CF (not enough water in the lumen so get meconium plug)
- Should be screened for CF
- XR shows transition point and possibly gas-filled plug
- Tx: water enema to dx and dissolve the plug
- Confirm CF with chloride test
- If CF: give vitamins ADEK, pancreatic enzymes, pulmonary toilet (prevent pulmonary infection)
3. Hirschprungs: (failure of migration of inhibitory neurons of distal colon - muscle can't relax so stool can not get through)
Palpable colon because distended
-Explosive diarrhea on DRE
-Patients can present with chronic constipation with overflow diarrhea
XR; good colon dilated, bad colon looks normal
TX: if at birth: do contrast enema like barium to see transition point
If later in life, do anal-rectal manometry - increased tone due to lack of inhibition
BEST TEST is biopsy that shows no Auerbach plexus -
Tx: surgically resect bad colon (looks normal but biopsies abnormal)
42
constipation
1. Hirschprungs
2. Voluntary holding
-Cognitive impairment are at a higher risk
-Usually when they begin toilet training or when they begin school for the first time
-Starts as voluntary but may become involuntary
-LIkely to see overflow incontinence and encopresis (stooling in the bed)
Dx: clinical
Tx: Bowel regimen - stool softeners and motility agents and behavior (tell kid it's ok to poop), disimpaction (under anesthesia)
3. Medication
4. Diet
5. Anatomy
43
Emesis
Normal feeds: formula colored, non-projectile, occurs after eating.
1. Bilious: (
- projectile
- green
- XR shows double bubble
a. malrotation: failure to rotate appropriately - could have strangulation of bowel. Normal uterine course (no polyhydramnios, no Down syndrome)
Dx: XR shows double bubble but normal gas pattern beyond. Can be confirmed with upper GI series
Tx: NG tube, intermittent suction, decompress. Will need surgery (especially if with volvulus)
b. Duodenal atresia: Failure to recanalize - leads to SBO. Can't absorb amniotic fluid so have polyhydramnios
-Associated with downs
-XR with double bubble with NO gas beyond
Tx: surgery
c. Annular pancreas: failure of apoptosis of pancreas - squeezes down on bowel
-Polyhydramnios, associated with Downs
-XR: double bubble with no gas beyond
Tx: surgery
d. Intestinal atresia: Caused by vascular accidents en utero such as cocaine
-Doesn't always have polyhydramnios
-NOT associated with downs
-XR: double bubble and multiple air fluid levels
Tx: surgery
Worried about short gut syndrome - malabsorption syndrome
Confront mom about medical issue or substance use
2. Non-billious:
- non-projectile
- not green
a. Tracheoesophageal fistula (5 different types)
- Gurgling/bubbling because breathing through gastric secretions
- Dx: NG tube that coils on XR because of blind pouch
- Tx: TPN, surgery
b. Pyloric stenosis
44
Neonatal Jaundice causes
Prehepatic (unconjugated): hemolysis or hemorrhage
Intrahepatic (mixed):
-Crigler Nigar - look like pre
-Gaillvair - looks like pre
-Dubin-Johnson - excretion - looks like post
-Rotars: excretiion - looks like post
-hepatitis
Posthepatic(conjugated, direct): biliary atresia, sepsis, metabolic derangements
45
Kernicterus
Conjugated bilirubin cannot cross BBB and is water soluble - easily excreted in urine
Indirect/unconjugated is fat soluble - can pass membranes easily. Not excreted in urine and CAN cause BBB and lead to kernicterus
46
Physiologic jaundice
```
Onset: after 72 hours
Resolution: <1 week
Bili: Unconjugated
Rise: <5 units/day
Workup: Coombs test
-if positive - treat with isoimmunization
-if negative - look at hemoglobin
```
If hemoglobin low - indication of hemorrhage which could be cephalohematoma. If elevated, there is some transfusion (twin-twin transfusion, delayed clamping, maternal)
-if normal - check reticulocyte.
If reticulocyte count elevated then there is hemolysis (G6PD deficiency, pyruvate kinase, or Hgb SS disease). If normal - reabsorption issue (breast milk and breast-feeding)
47
Pathologic jaundice
```
Onset: within one day
Resolution: >1 week
Bili: Conjugated
Rise: >5 units/day
Workup: US, HIDA after phenobarb, causes of sepsis, metabolic disease?
```
48
Breast feeding jaundice versus breast milk jaundice
Breast feeding: problem with quantity - not fed enough so bili sits around and gets reabsorbed. Feed baby more. Unconjugated.
Breast milk: Problem with quality.
Inhibits conjugation so unconjugated bili. Feed baby with hydrolyzed formula.
49
Treatment of epilepsy
Levetiracetam (Keppra)
Phenytoin
Valproate
Lamotrigine
Ethosuximide (absence seizures)
Carbamazapine (trigeminal neuralgia)
50
Febrile seizure
```
Fevers reduce seizure threshold
If simple (1 in 24 hours, lasts <15 minutes, generalized)
```
tx: benzo to abort
for simple: give antipyretics (Tylenol) NO IMAGING
If complex seizure: EEG? LP? MRI? Likely placed on antiepileptics
51
Infantile Spasm
```
<1 yo
bilateral symmetrical limb jerking (not generalized, no fever)
EEG shows interictal hypsarrythmia
Tx: ACTH
Likely end up with mental retardation
```
52
Tuberous sclerosis
Genetic disease
<2 yo
Angiofibromas or ash-leaf spot
Afebrile seizures or complex febrile seizures
Dx: CT or MRI will show tubers
Tx; supportive. Kids will die young and have mental retardation
53
Absence seizures
```
100-1000s seizures per day
+ LOC but no loss of tone or post-ictal state
Confused with "ADHD"
Dx: EEG
Tx: Ethosuximide (valproate as backup)
Most kids outgrow
```
54
GI bleed in premature infant
NEC
XR: pneumatosis intestinalis (air in the bowel wall)
Tx: NPO, TPN, IVF, IV abx
55
GI bleed in neonate
Anal fissure likely caused by fecal incontinence
56
GI bleed in toddler
Intususception (telescoping of bowel into itself that leads to bowel compromise)
Sxs: abrupt onset, colicky abd pain. Knee-chest position brings relief. Can result in currant jelly diarrhea
Exam: sausage-shaped mass usually in RUQ
Dx: US to track progression shows target sign
KUB to identifiy perforation and obstruction
Tx: air enema. If not improved, go to surgery (or peritonitis, perforation)
Meckel's diverticulum: remnant of vitelline duct with gastric contents
Sxs: painless, intermittent, hematochezia
<2 years old
<2% of popul
2x more likely in male
2 feet from iliocecal vale
2 inches in length
kid with "colon cancer" suspect meckel's (+ Fecal occult test positive or iron deficiency anemia)
Dx: Technician 99 scan
Tx: resection
(CT scan is better in teenagers)
57
Inflammatory bowel disease in kids
Crohn's: watery diarrhea and weight loss
- See skip lesions
- medical therapy
Ulcerative colitis: bloody diarrhea
- colonoscopy shows continuous lesions
- surgery curative
- Increased risk of colon cancer (yearly colonoscopy started 8 years after dx)
Infectious: Fever and bloody BM
-Get stool cultures
Milk-protein allergy: GI bleed
-Change to hydrolyzed formula
58
Acute allergies
```
Type 1
Acute: IgE mediated. Exposure to trigger, cross-linking of mast cells which degranulate and release histamine
Anaphylaxis:
-urticaria all over body
-hypotension
-wheezing and loss of airway
Dx: clinical
tx: epinephrine, H1 and H2 blockers, steroids
```
```
Urticaria:
-wheal, whelt or erythema
-No hypotension
Dx: clinical
Tx: self-limiting. Observe or topical antihistamines
```
```
Angioedema:
-swelling usually in one spot
-associated with ACE inhibitor
-swelling airway
-No hypotension
can be C1 esterase deficiency (Tx with FFP)
Dx: Clinical
Tx: secure airway, H1/H2 blockers, steroids
```
59
Chronic allergies
Type 1
Allergic rhinitis: seasonal or perinneal (all the time)
Exam: shriners, salute (nose crease), pale, boggy mucosa, polyps with cobblestoning
Dx: Clinical
Tx: Avoidance of trigger and intranasal steroids (can also use H1/H2 blockers and leukotriene antagonists like montelukast)
Conjunctivitis:
- Shringers, conjunctival injection, chemosis
- Same dx and tx as above
Food allergies:
-Wheat, soy, milk, and eggs
-Nuts and shellfish can cause anaphylaxis
Sxs: nausea, vomiting, diarrhea. MIght have eczema or asthma
Dx; food trial
Tx: Avoid triggers. Use epi if anaphylaxis
Milk protein allergies:
-Soy formula
-Sxs: nausea, vomiting, diarrhea, could have bloody bowel movement. FTT
-Dx: clinical
Tx: change formula (use cow milk, breast, or hydrolyzed formula)
60
Developmental Quick
```
2mo lift head, social smile
4mo roll over
6mo sit up, stranger anxiety
1yr walk, stranger anxiety, 1 word
2yr steps, 2 word
3yr tricycle, 3 word, circle
4yr hopping, 4 word, cross
5yr skipping, 5 word, triangle
```
61
Meningitis
Fails positive: increased ICP so give abx, CT then LP. If Fails negative: LP and abx
Tx: Adult: Vanco, cephtriaxone, steroids
Peds (kids <30 days): Vanco, steroids, ampicillin, cefetaxime
62
Tx for scabies and lice
Permethrin
63
Tx for pinworm
Albendazole
64
HIV/AIDS
```
For kids <18 months, test with DNA PCR
HAART for any positive
Prophylaxis: 200 PCP with bactrim (then dapzone or atorvaquone)
100 toxo with bactrim or atovoquone
50 MAC with azithromycin
```
65
Causes of osteomyelitis
Staph aureus
| Salmonella (sickle cell kids)
66
Causes of septic joint
Staph aureus, gonorrhea
67
Pneumonia
<5year: mostly viral
TB: Ignore BCG
<5: get PPD
>5: get interferon gamma
Tx: RIPE for full blown or isoniazid with B6 for latent
68
Erythema infectiosum
```
Slapped cheek disease
Parvo B19
fever AND rash
Tx: supportive
IF hemoglobinopathy then worry about aplastic crisis and hydrops fetalis
```
69
Measles versus german measles (rubella)
Measles:
Parvomyxovirus
Prodrome: Cough, coryza, conjunctivitis, koplik spots
Fever AND rash: rash begins on face and spreads downward
Tx: supportive
Prophylaxis: MMRV
Can develop subacute sclerosing panencephalitis (brain disease later in life)
```
German measles (Rubella):
Prodrome: Generalized and tender lymphadenopathy
Fever AND rash:
Rash on face that spreads downward
Tx: supportive
Prophylaxis: MMRV
```
70
Roseola
HHV 6
Prodrome: Very high spiking fever (>104 degrees)
Rash occurs after fever breaks (Fever THEN rash)
Rash starts on trunk and extends outward
Tx: Supportive
71
Varicella zoster
Adult: shingles
Baby: chicken pox
Sxs: rash without fever - diffuse rash: vesicles on erythematous base in different stages of healing
Tx: Supportive
Prophylaxis: MMRV`1`
72
Mumps
Mostly in pubertal males that have parotid swelling and orchitis
Tx: supportive
Prophylaxis: MMRV
Orchitis may lead to infertility
73
Hand food and mouth disease
Cocksackie A
Looks like varicella but only on the hands, feet, and mouth
Tx: supportive
74
Head trauma
Epidural: Strike to head (ball sports and skiing)
- walk, talk, and die
- middle meningeal artery
- CT: lens shaped
Subdural: significant amount of trauma (pedestrian struck, MVA where thrown, shaken baby)
- LOC and coma
- CT: Crescent shaped
Contusion: deceleration injury
- LOC
- CT: punctate hemorrhages
Concussion: Head trauma with no bleed
- Sports injury
- Mild does not need CT
- Severe needs CT scan. If negative, still admit
75
burns
Parkland formula calculated by percent of body affected by burn (2nd and 3rd degree) x 4 x body weight
50% given in first 8 hours, 50% given in next 16 hours
76
Vaccinations
DTaP for kids: five doses
TDaP for adults: once in adolescence, then every 10 years
Pneumococcal mostly adults but can be kids too
Meningococcal everyone but especially college or military
HPV everyone
Heb A 3 doses, Heb B 2 doses
Flu everyone
77
Tetanus
Dirty wound
Lock jaw, spastic paralysis
Tx: Intubate, sedate, muscle relaxers, IV antibiotics (metronidazole)
78
Diphtheria
Fever, dysphagia, dypsnea
Pseudmembrane in mouth
Tx: Intubate to secure airway, anti-toxin and antibiotics
79
Pertussis
Phase 1: Catarrhal (infectious), nonspecific looks like cold
Phase 2: Paroxysmal cough with intermittent wheezing
Phase 3: Resolution
Tx: supportive and erythromycin
80
When to use tympanoplasty?
3 ear infections in 6 months or 4 ear infections in 12 months
81
Otitis externa
```
Swimmers ear: pseudomonas
Digital injury/picking: Staph
Worse with pulling of pinna
Tx: waiting. If ear is nasty, then use cipro drops and steroid drops.
Ensure they don't have mastoiditis
```
82
CENTOR criteria
```
For strep:
Cough
Exudates
Nodes
Temp >38deg
OR <14yo (+1), >44 (-1)
<1 viral
2-3 do rapid strep. Can do culture
>4 treat with Abx
```
83
Epistaxis
Usually trauma
Normal if unilateral, lasts less than 30 minutes
Tx: lean forward, apply pressure or ice
Anterior bleed: cauterize with nitrate sticks
Posterior: packing and prophylactic antibiotics
84
Choanal atresia
```
Pathway from nose to trachea is blcoked
baby turns blue when feeding, pink when crying
Childhood snoring
Dx: pass catheter
Tx: surgery
```
85
Croup
```
caused by parainfluenza
3mo-3year
Barking, seal-like cough with stridor
Moderate: Give racemic epi or dexamethasone
Severe: admit
```
86
Bacterial tracheitis
```
Staph aureus
Wide age group, mostly 4 years
Croup that does not improve with treatment
Might be toxic-appearing
Dx: Tracheal culture
Tx: Abx
```
87
Epiglottitis
H flu - vaccine so decreased prevalance
3-7 years old
VERY sick- rapdi onset high fever, tripod, drooling, using accessory muscles, hot potato/muffled voice
Visualize cherry-red epiglottis with endotracheal tube in the OR to secure airway
Then Abx
88
Retropharyngeal abscess
Oral flora
Very sick, abrupt onset of high fever, drooling, neck extended, neck stiffness, drooling with hot potato voice
Anterior chain unilateral lymphadenopathy and tender mass (abscess)
Dx: CT scan
Tx: I&D and antibiotics
89
Peritonsillar abscess
```
Oral flora
Age >10
Hot potato voice, drooling, dysphagia/odynophagia, uvular deviation (tonsils shifted)
Dx: clinical
Tx: drain and antibiotics
```
90
Foreign body airway obstruction
Foreign body
<3, unattended, sudden onset of SOB
Intrathoracic causes expiratory wheeze
Extrathoracic causes inspiratory stridor
Dx: XR 2 view - coin sign (neg on AP, + on lateral =in the trachea)
Tx: Abx if bacterial infection developing. Otherwise remove with bronchoscopy (lungs), endoscope (GI), or laryngoscope (ENT)
91
Bronchiolitis
RSV
<2yo
Wheezing, dyspnea but in winter months and no other symptoms of asthma
Tx: Oxygen and fluids
92
Cystic fibrosis
```
Autosomal recessive of CFTR gene
Diagnosed by prenatal screens
See with meconeum ileus on day of birth
Recurrent pulmonary infections
Failure to thrive
Baby tastes salty
Dx: screen, then sweat chloride (>40 infant, >60 older)
Tx: lung: pulmonary toilet to move secretions, fight pseudomonal pneumonia
```
Pancreas: pancreatic enzymes, vitamin ADEK supplement
93
Tobacco use in pregnancy
Low birth weight
94
Alcohol use in pregnancy
FAS: facial abnormalities, growth deficiencies, CNS dysfunction
95
Heroin use in pregnancy
Increased risk of fetal growth restriction, placental abruption, fetal death, preterm labor, meconium
96
Cocaine use in pregnancy
vasoconstriction - placental insufficiency and low birth weight
97
Term infant caloric requirement
100-120 cal/kg/day = gain of 20-30g/day
98
Vaccines
```
DTaP - five doses
IPV (Polio) - 4
Hib - 3 or 4
PCV13 - 4
MMR - 2
Varicella - 2
RotaV - 2 or 3
HepA - 2
HepB - 3
```
99
Neuroblastoma
Infants less than one year - tumors may spontaneously regress
elevated urine catecholamines (VMA and HVA)
Painless mass in the neck, chest, or abdomen but could be chronically ill or have bone pain from mets
Fever, pallor, weight loss
Commonly RUQ mass
100
Nephroblastoma (Wilms' tumor)
Asymptomatic RUQ abdominal mass
Rarely cross the midline
May be associated with abd pain and vomiting, may be hypertensive
101
Non-sedating antihistamines
loratadine, fexofenadine, cetirizine
102
Screening for DM
```
overweight (BMI>85th%, weight >120% of ideal)
Any two of following:
family hx of DM
race/ethnicity at higher risk
signs of insulin resistance
maternal hx of GDM
```
Screen at 10 years of age, q3 years
103
Management of prehypertension in children
90-95th%ile
lifestyle changes
Follow up in six months
104
Order of puberty stages
```
Girls: 8-13
Breast
Hair
Growth spurt
Periods
```
```
Boys 10-15
Testicles
Hair
Penis, scrotum
Ejaculations (13)
Growth spurt
```
105
Precordial catch syndrome
most common cp
sudden, sharp pain, worse with inspiration
resolve spontaneously
106
Transient tachypnea of newborn
Delayed clearance of fluid from lungs at birth
More common in diabetic mothers and C-section delivery
XR: "wet" looking lungs, no consolidation
107
Respiratory distress syndrome
Def. of lung surfactant
Most common cause in premies
Increased risk in diabetic mothers
XR: "Ground glass appearance" - diffuse reticulogranular appearance
108
Congenital adrenal hyperplasia (21 OH def)
Decreased production of cortisol and aldosterone
Elevated 17-Oh progesterone
Increased androgens
109
Bronchiectasis
XR: Hyperinflation, increased interstitial markings, peribronchial cuffing, scattered atelectasis
110
Diagnostic criteria for DKA
A random blood glucose of > 200 mg/dL (> 11.1 mmol/L)
| A venous pH < 7.3 or serum bicarbonate < 15 mEq/L (< 15 mmol/L), and Moderate or large ketonuria or ketonemia
111
Maintenance fluids
100 mL/kg/day for the first 10 kg of body weight
50 mL/kg/day for the second 10 kg of body weight
20 mL/kg/day for each additional 1 kg of body weight
112
Ibuprofen dosing
Pediatric dose: 10 mg/kg every 6-8 hrs PO (maximum dose = 40mg/kg/24 hr PO) Concentration of oral suspension: 100 mg/5 mL (20 mg/1 mL)
113
Murmur of ASD
Fixed, split S2 and systolic murmur (increased flow across pulmnonic valve)
114
Sound of bicuspid aortic valve
Early systolic click
115
Murmur of VSD
Holosystolic, blowing
116
Pulmonic stenosis
Harsh systolic ejection murmur with click just after S1
117
PDA
Continuous murmur
