Pediatrics > Pediatrics Exam 2 > Flashcards

Pediatrics Exam 2 Flashcards

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1
Q

What are causes of shock lesions in the newborn?

A
  • Critical Pulmonary Stenosis
  • Aortic Coarctation/Interrupted Aortic Arch
  • Critical Aortic Stenosis
  • Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)
  • Tachyarrhythmias
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2
Q

what are examples of systemic obstructive lesions?

A
  • Aortic Stenosis
  • Interrupted Aortic Arch
  • Aortic Stenosis
  • Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)
  • Tachyarrhythmias
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3
Q

Newborn presents with poor feeding, tachypnea, decreased LE pulses, and gradient by cuff pressure >10 mm Hg; however, it passed the newborn pulse oximetry test. What is the diagnosis?

A

Coarctation of the Aorta

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4
Q

What should a Coarctation of the Aorta be treated with?

A

Prostaglandin E1

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5
Q

In a Patent Ductus Areriosus (PDA) pt, what may not be detected in a newborn with coarctation of the aorta?

A

gradient by cuff pressure >10 mm Hg (may not detect until PDA closes)

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6
Q

Why should a coarctation of the aorta be followed for lifetime?

A

A coarct will develop collaterals over time and have rib notching on X-ray
Older presentation: systolic HTN, fatigue, leg pain (claudication)

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7
Q

Pt presents with poor cardiac output, irritability, CHF, and poor feeding at 2 minutes. What is the dx?

A

Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)

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8
Q

What initial management steps should be taken for suspected newborn cardiovascular issues?

A

Airway, Breathing, Circulation (ABC’s)
Vascular access (IV-resuscitate)
Antibiotics (always start)
Prostaglandin E1

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9
Q

For any newborn in shock, what should be considered?

A

Prostaglandin E1

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10
Q

What should always be checked in newborns?

A

pulses, if there is ANY doubt –> refer

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11
Q

If 3 month old presents w/ tachypnea, what do you suspect?

A

ALCAPA

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12
Q

Which newborn lesions have less sensitivity with screening?

A

Left sided lesions

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13
Q

Pulse oximetry screening is a poor test for?

A

lesions that cause systemic obstruction (coarctation, aortic stenosis)

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14
Q

What should you do w/ newborn who presents with blue brain and pink feet?

A

Suspect D-Transposition of the Great Arteries (D-TGA)
Immediately refer to open atrial septum (add PDA)
put in IV, resuscitate to reverse differential saturations
Start Prostaglandin E1

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15
Q

What should be obtained in all children who fail the hyperoxia test?

A

An echo or transport

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16
Q

What are important things on the newborn physical exam to note for cardiac issues?

A

liver edge (heptomegaly)
feeding endurance
check pulses in upper and lower extremities
characterize chest pain

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17
Q

What are signs of cardiac ischemia?

A

happens w/ activity
chest pain
extreme SOB
radiating pain

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18
Q

If pt has a single ventricle (e.g., Hypoplastic Left Heart Syndrome (HLHS)), what is required for treatment?

A

3 staged surgery repairs over the first 3 years

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19
Q

Which stage in a single ventricle condition is most high risk?

A

Stage 1

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20
Q

What type of management does a single ventricle require?

A

cardiologist

lifelong f/u due to increased risk for arrythmias

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21
Q

feeding intolerance is a red flag for?

A

single ventricle

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22
Q

shunting at the atrial level is determined by what?

A

ventricular compliance (how stiff ventricles are) NOT pressure difference

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23
Q

shunting at the ventricular level is determined by what?

A

relative SVR and PVR (resistance)

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24
Q

What is the outpatient management for congestion in CHD?

A

adequate calories until child is “big enough” for surgery (fortify feeds, tubes, etc.)
diuretics

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25
When should a cardiologist be notified in outpatient management of congestion in CHD?
excessive changes in weight (up or down) | new symptoms or progression of current symptoms
26
In Atrioventricular Canal (AVC), shunting occurs due to what?
increase in qP (pulmonary flow)- (oxygen poor blood)
27
T or F: In Atrioventricular Canal, there is early congestion
True
28
When does differential cyanosis occur?
when the PDA shunts R to L blue blood to the lower extremities
29
what is the timing of CHF for Patent Ductus Arteriosus (PDA)?
days to weeks
30
what is the timing of CHF for Atrioventricular Canal?
weeks to months
31
what is the timing of CHF for Ventricular Septal Defect (VSD)?
weeks to months
32
what is the timing of CHF for Atrial Septal Defect (ASD)?
years to decades
33
what are stills?
innocent murmur- no intervention needed, but f/u all innocent murmurs in children <2 yrs old vibratory ejection murmur louder when lying down ("flicking guitar string")
34
What murmur is never innocent?
diastolic murmur
35
In a hyperoxia test, if PaO2 <150 mmHg after 100% O2 delivery suggest what?
blood is bypassing the lungs via a congenital heart defect
36
What are normal physiological responses to fever?
increased heart rate and respiration rate
37
fevers seen in what age should be sent to the ER?
<2-3 months old | high fever can precipitate seizures
38
What temperature defines pediatric fever?
>100.4 degrees F taken via the rectum, ear, or temporal artery
39
Should you believe the parents when they state that they feel their child has a fever?
Yes, this is a reliable predictor of fever
40
What should be recommended if a fever is detected via a route other than the rectum?
Recommend to parents to double check an infant w/ a rectal temperature
41
What should be included in the pt history if a child presents with fever?
- Recent immunizations - Hx of sick contacts (especially siblings) - Treatments, including abx/antipyretics - Travel - Hospitalizations or hx of immune compromise - Change in mental status, eating, drinking, lethargy, apnea, irritability
42
What history questions should be asked if a neonate presents with fever?
- Is there poor feeding? - Vomiting or signs of dehydration? - Apneic episodes? - Changes in the social interaction or in crying? - Birth history (to explore prematurity, maternal infection, or congenital conditions)
43
What age group should avoid NSAIDs (e.g., motrin)?
<6 months old | okay to give acetaminophen
44
In a child w/ fever, what should you note in general appearance?
-Social smile is reassuring -Children >8 months old should normally fear strangers, serious illness likely if child doesn't respond in this fashion
45
If a child presents w/ fever and petechiae/rashes, what should you suspect?
bacterial infection
46
If a child presents w/ fever and mottling, what should you suspect?
toxicity
47
In a child w/ fever and capillary refill >2 seconds, what should you be concerned about?
hypoperfusion/hypovolemia
48
What should be done if a child presents w/ fever and dyspnea/tachypnea/grunting/flaring/retractions?
further workup with pulse ox and chest x-ray
49
What are signs of dehydration in an infant?
dry mucosa, lack of tears, sunken fontanelle, decreased urine output by hx (typically 3+x/day )
50
What are signs of lethargy in an infant/child?
decreased level of consciousness absent eye contact decreased ability to recognize parents
51
child presents w/ fever and lethargy w/ poor perfusion. What do you suspect?
toxicity
52
child presents w/ fever and cyanosis, what do you suspect?
toxicity
53
child presents w/ fever and respiratory distress, what do you suspect?
toxicity
54
child presents w/ fever and cold hands/feet, limb pain, mottled/pale skin. what do you suspect?
toxicity
55
What factors increase the risk of bacteremia/sepsis?
- < 2 months old - immunocompromised (low WBC, cancer) - under/unvaccinated - hypothermia (<98 degrees) or hyperthermia (>105 degrees) - implanted medical devices (pacemaker, shunt, central line) - sickle cell disease - asplenic - HIV (+)
56
Children w/ cystic fibrosis are susceptible to what?
pneumonia
57
Infants <60 days old should be referred to an ED for what?
full sepsis workup
58
In a bacterial infection, what lab values can you expect in a CSF analysis?
WBC count >15,000 (neutrophils >1000), protein >200, glucose <40
59
When is an evaluation for herpes simplex indicated for a febrile infant?
- < 3 wks old - vesicles are present - seizures - toxic/ill appearance - maternal hx of herpes and vaginal brith
60
febrile neonates are often ______ while pending outcome of cultures
hospitalized and treated w/ empiric antibiotics
61
what should be included in the workup for infants <28 days old, hx of prematurity + underlying medical condition, or high risk of serious bacterial infection?
- urine - CBC - blood culture - CSF - chest x-ray - viral panel
62
what is the appropriate action if a full sepsis workup is needed in an infant?
hospitalize and treat w/ IV antibiotics pending culture outcome
63
What are indicators of low risk for serious bacterial infection in infants?
- nontoxic (no lethargy or poor perfusion) - previously healthy - no bacterial focus skin, skeletal or soft tissue - good social interaction (alert, looking around) - normal WBC in UA and stool (5000-15000)
64
Why is epiglottitis nearly eliminated?
HIB vaccine
65
Children ages 2-24 months w/ fever >102.9 are at risk for what?
occult bacteremia (especially if under-immunized or immunocompromised)
66
febrile children ages 2-24 months w/ symptoms of bronchiolitis are a lower risk for what?
both bacteremia and UTI | cultures w/ healthy appearing children unneccesary
67
what labs are discouraged in febrile but well-appearing immunocompetent children ages 2-24?
CBC and blood cultures
68
what antibiotics are not recommended in febrile children ages 2-24?
broad spectrum
69
what lab is recommended in ALL febrile females w/o source?
urine culture
70
what lab is recommended in febrile males <6 months old?
urine culture
71
what labs should be obtained in febrile children ages 2-24 w/ lethargy, toxicity, irritability, inconsolableness, signs of shock, or petechial rash?
urine, blood, and CSF cultures
72
what are common causes of fever in children ages 2-24 months?
viral: RSV, influenza A/B, HHV-6 "roseola", enterovirus in the summer, adenovirus, COVID bacterial infection: OM, nasal FB, periorbital cellulitis
73
fever w/ diarrhea is typically viral except if ____
it contains blood/mucus or there has been recent antibiotic use
74
what course of action should be taken for a fever <102.2 degrees in a child aged 2-24 months?
evaluate, antipyretics and f/u | if fever lasts >5 days --> concerning
75
what course of action should be taken for a fever >102.2 degrees in a child aged 2-24 months?
if toxic or immunodeficient: full septic workup, IV antibiotics Non-toxic: guided by screening tests
76
What testing is recommended for febrile children ages 2-24 months presenting w/ complex febrile seizure, full anterior fontanelle, persistent irritability, lethargy/inconsolability, or petechial rash?
lumbar puncture
77
What course of action should be taken with children >24 months w/ low grade fever, no risk factors, no focus and no irritability?
treat symptomatically, no labs needed
78
innocent murmurs always have ____ S1, S2
normal
79
chest pain/syncope with exertion is a red flag for?
CARDIAC ISSUE
80
which cardiac lesion causes 2/6 SEM at the LUSB?
pulmonary stenosis
81
large male newborn w/ single S2, no murmurs | O2 sats 55% on hand and 75% on foot
D-TGA (D- Transposition of the Great Arteries) pre-ductal/brain O2 SAT > feet O2 SAT
82
which cardiac lesion causes 4/6 SEM at the LUSB, high pitched?
pulmonary stenosis

Pediatrics (7 decks)

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