pulm and cardio

Question 1

Preterm infant still requiring supplemental oxygen at 4 weeks (>/=28 days). What is the diagnosis and mechanism of condition?

Answer 1

Bronchopulmonary dysplasia!!

Arrest of pulmonary development - reduced separation of alveoli!!

Question 2

Patient with episode of drowning. Asymptomatic. Next step in management?

Answer 2

Admit in hospital for observation due to risk of delayed pulmonary complications particularly acute respiratory distress syndrome!!

Question 3

Night time snoring, mouth breathing during the day. Most likely diagnosis? Management?

Answer 3

Paediatric obstructive sleep apnea
Tonsillectomy and adenoidectomy

Eneuresis, sleep walking and sleep terrors can also occur

Question 4

Meconium aspiration findings?

TTN findings?

Neonatal respiratory distress syndrome finding?

Answer 4

Bilateral patchy infiltrates. Term and post term infants. Meconium stained amniotic fluid

Interstitial infiltrates with prominent interlobular fissures often seen in preterm . Might need oxygen support and cpap but Invasive respiratory support unlikely to be needed as would be needed in ards

Diffuse reticulogranular pattern with air bronchograms

Question 5

Conditions mimicking ADHD?

Answer 5

1. Obstructive sleep apnea
2. Absence siezure
3. Learning disabilities
4. Hearing impairment
5. Mental health conditions

Question 6

ADHD symptoms but snoring and obesity. Next step in work up?

Answer 6

Sleep study!

Question 7

VSD and AVSD can cause HF in infants. Manifest in infants as failure to thrive, poor ceding poor growth. Diaphoresis and tiring with feeds

Question 8

Respiratory distress syndrome. Unilaterally decreased breath sounds on left side and left chest brightness with trans illumination. Heart sounds loudest on the right.

Next step in management?

Answer 8

Needle thoracostomy!!!

Keeping with tension pneumo!!

Rfs = RDS, mechanical ventilation, Meconium aspiration

Question 9

Cyanosis in first 24 hours of life and single loud S2 on auscultation. Most likely diagnosis?

Answer 9

TGA

Question 10

Persistent pulmonary hypertension of newborn finding?

Answer 10

Low post ductal saturations eg right foot compared to oreductal eg right arm

Due to persistence of PDA

Question 11

2 week old. Premature ICU, NG tube feeds. Low birth weight. Increasing episodes of apnea and abdominal distension

Answer 11

Abdominal x ray - looking for air in bowel!! and air under diaphragm

Other possible symptoms, = bloody stools , poor feeding, bilious Emesis

Question 12

Pleural effusion but leukocyte count was greater than 50,000 and LDH was greater than 1,000. Most likely diagnosis? Ph less than 7.2

Answer 12

Empyema!

Question 13

Feeding difficulty so catching breath and spitting up, stridor that only improves with neck extension. CXR shows tracheal indentation at T4. Next step in management?

Answer 13

CT angiogram of chest!!

Patient has vascular ring - double aortic arch encircling and compressing esophagus and trachea

Question 14

Treatment for apnea of prematurity?

Answer 14

Caffeine!!,
NIV

Question 15

Respiratory distress , rounded shaped chest and flat abdomen, absent breath sounds on left chest. Next step in management?

Answer 15

Endotracheal intubation!!,

Followed by nasogastric tube insertion

Patient has congenital diaphragmatic hernia

Question 16

Benign murmur signs?

Answer 16

Low pitched
Early or mid systolic timing
Musical or vibratory
Otherwise asymptomatic
Splitting of S2 during inspirationn is a normal finding!

Pulmonary stenosis is a common cause

Question 17

Tetralogy of fallot causes tet spells

Question 18

RDS management?

Answer 18

Apnea or gasping?
No = Cpap
Yes = intubate and ventilate following bag valve mask

Question 19

Epiglotitis first step in management?

Answer 19

Endotrachel intubation !!

Lateral x ray not always needed and intubation more key

Question 20

Viral infection and harsh cough with inspiratory Stridor. Pathogenesis of croup?

Answer 20

Edema and narrowing of proximal trachea!! And larynx

Question 21

Cystic fibrosis with pneumonia. What antibiotic should be started empirically?

Answer 21

Vancomycin!!
To cover for staph

Question 22

Persistent coughing and wheezing following a choking Episode. CXR was clear. Next step in management?

Answer 22

Bronchoscopy!!

Question 23

Congenital cyanosis. ECG shows tall p waves and left axis deviation. Decreased pulmonary markings on CXR and murmur in left lower region. Most likely diagnosis?

Answer 23

Tricuspid atresia

Question 24

Edward’s syndrome is associated with what cardiovascular abnormality?

Answer 24

VSD!! Also associated with atrial septal defect but this presents with fixed split S2.
Like downs

Question 25

Why does aortic coarctation treatment allow right to left heart shunting to continue

Answer 25

It’s allows the PDA to stay open and blood from pulmonary artery to supply the descending aorta Treatment is with alprostadil

Question 26

newborn, soft holosystolic murmur at left lower sternal border next step in management?

Answer 26

echo!!! = most likely a VSD - evaluate size and risk of HF not a benign murmur as although soft, the holosystolic timing of it is pathologic!!! early/mid systolic = benign holosystolic or diastolic = pathologic

Question 27

newborn with pulse oxximetry 90% in right hand, 70% in right foot and signs of meconium aspiration syndrome next step in management?

Answer 27

nitric oxide!!! -> persistent pulmonary hypertension of newborn!! treatment in addition to oxygen, ventilation meconium aspiration, infection eg neonatal pneumonia and lung hypoplasia eg congenital diaphragmatic hernia are all risk factors.

Question 28

5 minutes following birth, cyanosis limited to hands and feet and circumoral but not mucosal area (so no central cyanosis) next step inmanagemt?

Answer 28

reassurance and routine care!!! (which would include screening for CHD) baby has acrocyanosis

Question 29

infant with biphasic stridor, louder on expiration, improves with neck exstension. feeding difficulties most likely diagnosis?

Answer 29

Vascular ring other causes of stridor: -> laryngomalacia = inspiratory! stridor worse with feeding, crying or SUPINE positioning -> airway hemangioma = progressive biphasic stridor = concurrent skin hemangiomas

Question 30

Most common complication of bicuspid aortic valve in child?

Answer 30

- bacterial endocarditis! - Aortic aneurysm is less common

Question 31

6 month old. Decreases activity levels. Pulse 245/min and regular. Resp 32. BO 60/40z gray and poorly perused. ECG shoes supraventricular tachycardia (learn the imaging finding)

Answer 31

Cardioversion!!!! As patient is unstable. If stable = adenosine first line. Answer is NOT give fluids.

Question 32

Vsd can progress to HF. ECG can show right ventricular hypertrophy. Hepatomegaly can occur. And a key mechanism is increased PULMONARY VASCULAR RESISTANCE