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Flashcards in peds20 Deck (199):
1

def of CHF

inadequate ox delivery by the myocardium to meet the demands of the body

2

what do the kidneys do during CHF?

retain salt and water as an attempt to increase blood volume because the kidneys are being hypoperfused

3

catecholamines and CHF?

they are released to incr heart rate

4

how does incr pulm blood flow cause CHF?

it's just not what your heart is made to do; examples are VSD, PDA, transp of great arteries, truncus arteriosus, and total anomalous pulm venous conneciton

5

what obstructive lesions cause CHF?

severe aortic, pulm, and mitral valve stenosis, coarctation of the aorta, interrupted aortic arch, and hypoplastic left heart syndrome

6

infectious cause of CHF?

viral myocarditis (common in older kids), endocarditis, pericarditis,

7

evidence of pulmonary congestion

tachypnea, cough, wheezing and rales

8

evidence of impaired myocardial performance

tachycardia, sweating, pale or ashen skin, diminished urine output, and enlarged cardiac sillohuette on cxr

9

hepatomegaly and peripheral edema are evidence of what?

systemic venous congestion

10

late manifestations of CHF

cyanosis and shock

11

three types of drugs used for CHG

cardiac glycosides, loop diuretics, inotropes

12

how do cardiac glycosides work?

increase calcium-induced calcium release and therefore the force of contraction

13

example of cardiac glycoside

digoxin

14

ethacrynic acid

loop diuretic

15

how do inotropes work?

increase heart contractility

16

examples of inoropes

dobutamine, dopamine

17

how do phosphodiesterase inhib help CHF?

improve contractility and reduce afterload

18

balloon valvuloplasty used for what?

critical aortic and pulm valve stenosis

19

what percent of kids have an innocent heart murmur?

50%

20

still's murmur age, location, and characteristics

age 2-7 years; mid-left sternal border; grade 1-3 systolic vibratory or buzzing; loudest supine and louder with exercise

21

pulmonic systolic murmur (systolic ejection murmur)

any age; upper left sternal border; grade 1-2, peaks in early systole; blowing, high-pitched, loudest supine and louder with exercise

22

venous hum- age, location, and characteristics

any age, but esp school age; neck and below the clavicles; continuous murmur, heard only sitting or standing; disappears if supine; changes with compression of the jugular vein or with neck flex or extension

23

ostium primum

ASD in the lower portion of the atrial septum. Often associated with cleft or division in the ant mitral valve leaflet and cause mitral regurg

24

ostium primum more common in what population?

down syndrome

25

ostium secondum

ASD in the middle portion of the atral septum. Most common type of ASD

26

sinus venosus

ASD high in the septum near the junction of the right atrium and SVC. The right pulm vein drains anomalously into the right atrium or SVC instead of into the left atrium

27

symptoms of acyanotic heart disease

minimal; incr RV impulse, systolic ejection murmur (from excessive pulm blood flow)at mid and upper left sternal borders; mid-diastolic murmur and fixed split second heart sound

28

how does acyanotic heart disease cause mid-diastolic filling rumble

excessive blood flow through the tricuspid valve

29

how does acyanotic heart disease cause fixed-split heart sound?

excessive pulm blood flow causes the the normal variation in timing of aortic and pulm valve closure with resp to be absent

30

VSD murmur?

high pitched holosystolic murmur at LLSB and thrill at LLSB; as the size of the VSD decreases, the intensity of the murmur increases

31

PDA murmur

continuous "machinery like" murmur at ULSB; brisk pulses; diastolic rumble of blood across mitral st the apex;

32

phys exam fininds in coarctation of aorta

elevated BP in right arm, reduced BP in legs, delayed and dampened fem pulse; bruit left upper back

33

aortic stenosis murmur

ejection click; systolic ejection murmur at base with radiation to URSB, apex, suprasternal notch and carotids; thrill at URSB and suprasternal notch

34

murmur with pulm stenosis?

ejection click; systolic ejection murmur at ULSB

35

ECG findings in VSD

normal or mild LVH; RVH if pulm htn present

36

ecg findings in PDA

LVH; RVH if pulm htn present

37

ecg finding in coarctation of the aorta

normal or LVH

38

aortic stenosis findings on ECG

normal or LVH

39

pum stenosis finding on ecg

RVH

40

ASD finding on ecg?

right axis dev, rvh, and right atrial enlargement

41

small VSD prognosis?

may close spontaneously

42

what if VSD with 2:1 ul to systemic blood flow?

diastolic murmur of mitral turbulence (excess blood from lungs now passing through the mitral valve) heard at apex

43

eisenmenger syndrome

ehn PVR exceeds SVR and shunting shifts to R to L

44

ductus arteriosis

connects pulm art to aorta

45

management of PDA

indomethacin, can be closed surgically by coil embolization, thorascopic surgery, and ligation in a thoracotomy

46

coarctation of the aorta

narrowing of the aortic arch just below the origin of the left subclavian artery and typically at or just proximal to the ductus arteriosus

47

neonates with open PDA and coarctation

depend on R to L shuntthroug the PDA for perfusion of the lower thoracric and descending aorta; sx develop when the PDA closes

48

findings in older kids with coarctation of aorta

hypertension in right arm and bp reduced in lower extremities; radiofemoral delay

49

other findings in coarctation of the aorta

bicuspid aortic valve or aortic stenosis is present in half of kids (if either is present, you have systolic murmur); bruit through the coarctation may be heard at the LU back near the scapula

50

management of coarctation of the aorta

improve circulation to the lower body by IV prostaglandin E to open the DA, then inotropic meds; surgery but recurrence Is common so balloon angioplasty is the choice

51

aortic stenosis in the neonate may lead to what?

hypoplasia of the LV as a result of impaired fetal left ventricular development

52

initial management of aortic stenosis

balloon valvuloplasty, then surgery for aortic valve replacement (Russ procedure) after 5-10 yrs after palliative valvuloplasty bc of recurrent stenosis

53

ross procedure

aortic valve is replaced with the patient's own pulm valve

54

most common cardiac causes of central cyanosis

the 5 Ts: tetrology of fallot, tranposiiton of the great arteries, tricuspid atresia, truncus arteriosis, and total anomalous pulm venous connection

55

100% oxygen challenge test suggest cyanotic CHD when?

when PaO2 fails to rise despite administration of 100% ox

56

tetrology of fallot

VSD, overriding aorta, pulm stenosis, and RV hypertrophy

57

most common cause of central cyanosis

tetrology of fallot

58

murmor in tetrology of flalot?

systolic ejectrion murmur representing the pulm stenosis

59

what kinds of activities bring on cyanosis in a kid with tetrology of fallot?

things that decr SVR (exercise, vasodilation, volume depletion)or increase resistance through the RVOT (Crying, tachycardia)

60

Tet spells

sudden cyanosis and decr murmur intensity; caused by decr arterial ox sat, which increases resistance through the RVOT, resulting in incr R to L shunt

61

how does a kid deal with a tet spell?

squat; to incr venous return to the heart and incr SVR

62

management of tet of fallot?

surgical repair at 4-8 months old

63

some kids with tet of fallot who cannot undergo surgery right away get what?

palliative procedure to improve systemic saturation and encourage pulmonary growth; either modified Blalock-Taussig shunt or balloon pulm valvuloplasty

64

TGA

aorta arises from the RV and pulm art from the LV; in order to live, you must also have a VSD, ASD, PFO or PDA

65

physical exam in TGA

central cyanosis, single S2 and no murmur

66

management of TGA

initial management with PGE to improve ox sat by keeping the ductus patent; or emergent balloon atrial septostomy (rashkind procedure) that incr size of PFO or ASD

67

definitive repair of TGA

arterial switch operation; coronaries must also be incised and reimplanted

68

tricuspid atresia

plate of tissue on the floor of the right atrium; ASD or PFO is always present; whether or not a vsd is present determines the direction of blood flow

69

clinical signs of pulm atresia

single S2 (if intacts ventricular septum)

70

ECG finding in tricsupid atresia

left axis deviation, LVH, and right atrial enlargmenet

71

fontan procedure

flow from the IVC is directed into the pulm arteries; treatment for tricuspid atresia

72

glenn shunt

SVC is anastamosed to the right pulm artery

73

treatment for tricuspid atresia

glenn shunt and then fontan

74

truncus arteriosus

aorta and pulm artery originate from a common artery, the truncus; vsd is almost always present

75

pathophys of truncus

excessive blood flow to the lungs and CHF commonly develops; mixing of desat and sat blood occurs in the truncus so patients are mildly desat and sometimes cyanotic

76

murmur in truncus

systolic ejection mumur at the base from incr flow across the truncal vale; single S2; diastolic murmur across the mitral due to excessive pulm lood flow that returns to the LA

77

total anomalous pulm venous connection

pulm veins drain into the systemic venous side instead of the LA;

78

murmur in TAPVC

pulm murmur due to incr pulm blood flow

79

cardiomegaly with a snowman appearance

total anomalous pulm venous connection

80

most common cause of acquired heart disease in children in the US

kawasaki disease

81

most common cause of acquired heart disease worldwide

acute rheumatic fever

82

infective endocarditis

microbial infection of the endocardium (inside surface of the heart)

83

most endocarditis occurs in who?

80% in kids with anatomic defects of the heart; 50% of cases occur after cardiac surgery

84

bacteria that cause endocarditis

gram pos cocci (alpha hemolytic staph and strep)

85

rare causes of endocarditis

gram net and funghi

86

diagnosis of endocarditis

blood culture and ESR elevated

87

splinter hemorrhages

linear hemorrhages beneath the nails, seen in endocarditis

88

retinal hemorrhage

seen in endocarditis

89

osler's nodes

small, raised pink or blue swollen tender lesions on the palms, soles, or pads of the toes or fingers; sign of endocarditis

90

janeway lesions

small erythematous hemorrhagic lesions on the palms or soles; sign of endocarditis

91

roth's spots

ound or oval white spots seen in the retina; sign of endocarditis

92

rheumatoid factor

found in 50% of patients with endocarditis

93

how to see vegetations?

transesophageal echo is more sens than transthoracic echo

94

management of endocarditis

IV anitbmicrobials fr 4-6 weeks; not a medical emergency, so therapy can be withheld until you do cultures

95

who should get antibiotic prophylaxis for endocarditis for surgery?

al patients with structural heart disease except secundum ASD; all post-op cardiac surgery patients for 6 months; all post-op cardiac surgerypatients for an indefinite pd of time if any hemodynamic residua of the lesion remain

96

pericarditis

inflamm of the pericardial space

97

causes of pericarditis

infection, collagen vascular disease, uremia, and inflamm response after cardiac surgery

98

most common cause of pericarditis in kids

viruses like coxsackievirus, echovirus, adenovirus, influenza, parainfluenza, and EBV

99

purulent pericarditis

usually caused by bacterial infection like staph aureus and strep pneumo

100

patients with purulent pericarditis have a high incidence of what?

constrictive pericarditis

101

postpericardiotomy syndrome

occurs in up to 1/3 of patients whose pericardium has been opened for surgery; thought to be an autoimmune response to viral infx

102

possible consequence of pericarditis

cardiac tamponade

103

chest pain in pericardits?

most intense when supine and relieved when sitting upright

104

physical exam findingsin pericarditis

friction rub, distant heart sounds if effusion is large, pulsus paradoxus, hepatomegaly

105

rub

pericarditis or MI

106

pulsus paradoxus

abnormally large decrease in systolic bp during inspir

107

ecg in pericarditis MAY show

ST changes or low-voltage qrs complexes in patients with pericardial effusion

108

treatment for bacterial or viral pericarditis?

antibiotics or steroids/aspirin

109

myocarditis

common cause of sudden death in young athletes

110

etiology of myocarditis

viruses, esp enterovirus like coxsackievirus; bacteria, fungi, protozoa, autoimmune disease, kawasaki disease

111

bacteria that cause myocarditis

diptheria, strep pyogenes, staph aureus, tuberculosis

112

symptoms of myocarditis

resting tachycardia and muffled heart sounds;

113

labs in myocarditis

elevated ESR, creatinine kinase MB fraction, and CRP

114

management of myocarditis

largely supportive; use of ionotropes, etc. as needed; heart transplant as last resort

115

prognosis of myocarditis

variable; mortality 10-20% and is esp high in young infants and those with ventricular dysrhythmias

116

most common cause of dilated cardiomyopathy

idiopathic

117

other causes of cardiomopathy

viral myocarditis, mitochondrial abnormalities, carnitine def, nutritional def (selenium and thiamine), hypocalcemia, chronic tachydysrhythmia, anomalous origin of left coronary artery from the pulm artery (ALCAPA), meds (doxorubicin)

118

eval of cardiomyopathy

viral serologies and serum carnitine

119

ALCAPA can cause what?

infarction

120

hypertrophic cardiomyopathy

LVH in the absence of any disease known to cause it; most typical finidng is asymm septal hypertrophy

121

inheritance of hypertrophic cardiomyopathy

aut do n most cases

122

most common cause of sudden death in athletes

hypertrophic cardiomyopathy

123

phys exam findings for hypertrophic cardiomyopathy

harsh systolic ejection murmur at the apex that is accentuated with maneuvers that reduce LV volume like valsalva or standing (by reducing LV volume, they worsen the outflow obstruction)

124

findings on ECG for hypertrophic cardiomyopathy

LVH, ST-seg and T wave changes, LAD and abnormally deep and wide Q waves in the inferior and lateral leads

125

management of hypertrophic cardiomyopathy

only treat patients w symptoms; beta blockers of CCBs reduce the LVOT obstruction; surgical myomectomy; antiarrhythmic medications; dual chamber pacing; participation in competitive sports prohibited

126

restrictive cardiomyopathy

rigid ventricular walls that impair normal diastolic filling

127

etiology of restrictive cardiomyopathy

amyloidosis,inherited infiltrative disorders like Fabry disease, Gaucher disease, hemosiderosis, hemochromatosis

128

physical exam findings in restrictive cardiomyopahty

elevated central venous pressure leads to edema, hepatomegaly, and ascites

129

management of restrictive cardiomyopathy

reduce CVP with diuretics and improve diastolic compliance with beta blockers and CCBs

130

most common dysrhythmias of childhood

supraventricular tachy (most common), then heart block, and long QT syndrome

131

AV re-entrant tachycardia

retrograde conduction through an accessory path leads to SVT

132

AV node reentrant tachycardia

conduction abnormality occurs in diff pways within the AV node itself

133

Wolf-Parkinson white syndrome

when anterograde conduction occures through a bypass tract between the atria and ventricles

134

WPW associated with what?

sudden cardiac death

135

WPW on ecg?

delta wave (upslope of QRS with a short PR)

136

management of SVT

vagal maneuvers, IV adenosine, synchronized cardioversion, chronic med management, radiofrequency catheter ablation

137

vagal manuever that helps convert SVT to sinus rhythm

ice pack on face

138

primary med used to convert SVT to sinus rhythm

IV adenosine

139

chronic medical management of SVT

digoxin or propanolol

140

radiofrequency cathether ablation

used to destroy the accessory pway in SVT

141

heart blcok

delayed or interrupted conduction of sinus or atrial impulses to the ventricles

142

first degree heart block

prolongation of the PR interval

143

second degree AV block

type 1 and type 2

144

type 1 second degree AV block

aka wenkebach; progressive prolongation of the PR interval leading to failed AV conduction

145

type 2 second degree AV block

abrupt failure of AV conduction without progressive prolongation of the PR interval

146

third degree av block

complete block

147

congenital third-degree block associated with what patient pop?

children born to mothers with SLE

148

post-surgical AV block

as a result of cardiac surgery

149

what infection may be associated with AV block?

bacterial endocarditis

150

treatment of asymp AV block

cardiac pacemaker

151

why is long QT bad?

increases the risk of lethal ventricular arrhythmias known as torsades de pointes

152

different inheritance patterns of long qt syndrome

autosomal recessive is jervell-lang-nielsen syndrome; autosomal dom is romano-ward syndrome

153

which cause of long qt is associated with congenital deafness

jervell-lange-nielson

154

examples of drugs that prolong qt interval

phenothiazines, tricyclic antidepressants, erythromycin, tefenadine

155

phenothiazine

antipsychotic

156

terfenedine

antihistamine

157

most common cause of chest painin kids

pericarditis

158

rapid heart rate w absent p waves

superventricular tachycardia

159

difference between vesicles and pustules

vesicles are fluid filled and pustules are purulent filled

160

cyst

nodule filled with expressible material

161

wheals

cutaneous elevations caused by dermal edema

162

excoriations

linear erosions into the epidermis caused by fingernail scratches

163

fissures

linear cracks into the dermis

164

annular

configurated in a circle

165

arcuate

in half circles

166

distributions

generalized, acral (hands, feet, buttocks), confined to a dermatme

167

how can we identify fungal hyphae

add 10% koh

168

how do we identify scabies

examine under a microscope looking for mites, eggs, or feces

169

absorption through the skin of a kid

same as through the skin of an adult except premature infants because they have a thinner stratum corneum

170

hyperkeratosis

thickened skin

171

keratolytis

salicylic acids, urea, alpha hydroxy acids, and retinoic acid

172

destructive therapies (for warts, molluscum contagiosum)

high dose salicylic acid, podophyllin, 5-FU, cryotherapy, electrotherapy, and laser therapy

173

only low dose corticosteroids should be used where?why?

face and groin because these areas have thinner skin

174

local side effects of steroids

acne, hirsutism, folliculitis, striae (esp in axilla or groin), hyper- or hypopigmentation, atrophy, ecchymoses and telangiectasias, tachyphylaxis

175

tacrolimus ointment

immunomodulator used for atopic dermatitis

176

one to five percent sulfur

formulated with other meds, used for acne

177

tar

used for eczema and psoriasis

178

contact dermatitis

inflamm of the epidermis and superficial dermis secondary to direct contact with the skin by a sensitizing substance

179

two types of contact dermatitis

allergic contact dermatitis and primary irritant contacst dermatitis

180

allergic contact dermatitis

T cell mediated

181

common causes of allergic dermatitis

poison ivy, oak or sumac; nickel containing jewelry and belt buckles; topical lotions and creams, perfumes, soap

182

clincial features of allergic dermatitis

erythematous papules and vesicles

183

treatment of allergic dermatitis

topical steroids

184

primary irritiant contact dermatiits

substance irritates the skin (not an allergic reaction); reaction is dose-dependent unlike allergic dermatitis

185

most common type of primary irritant dermatitis

diaper dermatitis

186

secondary infection with what on diaper dermatitis?

candida albicans

187

clinical features of diaper dermaitis

erythema with papules on the upper thighs, buttocks, and genitourinary area WITHOUT involvement of the inguinal creases

188

involvement of the inguinal creases may suggest what

candida superinfection

189

seborrheic dermaitits predominantly affects who?

infants and adolescnets

190

seborrheic dermatitis

cause unknown maybe due to a yeast that lives in areas that overproduce sebum;

191

clinical features of seborrheic dermatitis

red scales and crust in areas with high numbers of sebaceous glands (scalp, face, chest, groin); skin lesions may be greasy

192

seborrheic capitus

aka cradle cap dermatitis limited to the scalp

193

management of seborrheic dermatitis

low potency topical steroids, anti-fungals, sulfur, zinc, or salycilic acid shampoos

194

ptyriasis rosea

uncommon before 5 years old but extremely common in late childhood and adolescence

195

atopic dermaitits

aka eczema

196

clinical features of pityriasis rosea

malaise/ache, then solitary large red lesion (herald patch) on the trunk or upper extremities present for 1-30 days; THEN oval red macules and papules erupt for 3-6 weeks from chin to midthigh in christmas tree distrib

197

are pityriasis rosea lesions pruritic?

in about 50% of cases

198

managemnet of pityriasis rosea

topical or systemic antihistamines; exposure to UV light may shorten the disease course

199

psoriasis in kids?

way more common in adults