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My Peds > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

most common congenital heart defect (CHD)

A

Bicuspid aortic valve

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2
Q

In the first week of life, __________ of the great arteries most frequent cause of cardiac cyanosis

A

D-transposition

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3
Q

If there is an abnormal arrangement: suggests high likelihood of complex __ disease*

A

cv

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4
Q

Fetal circuation (3):

A
  • RV delivers blood to both pulmonary and systemic circulation (DA)
  • LV delivers blood to the systemic and placental circulation
  • Allows for fetal survival in utero despite complex lesions
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5
Q

02 blood from placenta (2):

A
  • Po2: 32-35 mm Hg

- 02 sat 80%

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6
Q

Fetal Circulation: Venous blood goes two ways

A
  1. Umbilical venous blood > foramen ovale > LA

2. Abdominal IVC blood joins the SVC drainage (P02=12-14, sat =40%)

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7
Q

In fetal circulation - Due to high _____, >90% of blood from the RV passes from the PA via the DA in to the descending aorta

A

PVR

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8
Q

Fetal Circulation: decending aorta sats

A
  • P02:20-22

- sat 55%

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9
Q

Lower p50 of fetal hemoglobin facilitates

02 uptake in the _______.

A

placenta

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10
Q

___ has a higher output than the ___ in fetal circulation. ____ RV:LV output

A

RV

LV

1.3:1

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11
Q

Transitional Circulation (4)

A
  • increase in SVR
  • rapid drop in systemic venous return to the IVC due to umbilical venous flow is removed
  • RA pressure decreases
  • LA pressure increases due to increase in PBF and pulm venous return
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12
Q

CO increases ______ after birth

A

30-80%

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13
Q

FO closes functionally at birth but increases ___ can cause the flap to reopen

A

RAP

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14
Q

R > L shunt can happen from (7): P-CLASHH

A
  • pain
  • crying
  • lung disease
  • acidosis
  • sepsis
  • hypoxia
  • hypercarbia
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15
Q

Ductus Arteriosus functional closure, anatomic closure?

A

72 hours of life

1-3 months

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16
Q

PDA s/s (5):

A
  • hyperactive precordium
  • hepatomegaly
  • bounding pulses with a wide pulse pressure
  • tachypnea
  • tachycardia
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17
Q

Blood volume: premie, < 3 months, 3-12 months, >12 months:

A

Premature: 100-120ml/kg
<3 months: 90
3-12 months: 80
>12 months: 70

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18
Q

Newborn: In order to increase CO, must increase ____

A

HR

Increase in preload causes little or no change in cardiac output

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19
Q

Cardiac physiology at birth: innervation (2)

A
  • Parasympathetic innervation is fully functional at birth

- Sympathetic innervation: increases HR and contractility is incompletely developed (can pretreat with atropine)

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20
Q

What does not change in a newborn?

A: stroke volume
B: slower heart rate
C: higher blood pressure
D: cardiac output

A

A: stroke volume

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21
Q

The hallmark of intravascular fluid depletion in neonates and infants is?

a. hypotension
b. hypotension with tachycardia
c. hypotension without tachycardia
d. hypertension

A

c. hypotension without tachycardia

22
Q

A concern for paradoxical air embolism may occur in the neonate because of?

a. mitral stenosis
b. patent foramen ovale
c. rate regulated cardiac output
d. changes in blood pressure

A

b. patent foramen ovale

23
Q

Normal Vital Signs for infant

A
  • HR: 120-160
  • RR: 30-60
  • Premature BP: 50/25
  • Neonate BP: 70/40
  • EGA in weeks : goal for MAP in first few weeks of life (aka 38 weeks, MAP 38)
24
Q

most common ASD? Where?

A

Secundum ASD – at the Fossa Ovalis

25
Q

ASD that is lower in position & is a form of ASVD, MV cleft.

A

Primum ASD

26
Q

ASD that is high in the atrial septum, associated w/partial anomalous venous return & the least common.

A

Sinus Venosus ASD

27
Q

ASD S/S (5):

A
  • Most are asymptomatic but may have easy fatigability or mild growth failure.
  • Cyanosis does not occur unless pulmonary HTN is present.
  • Hyperactive precordium, RV heave, fixed widely split S2.
  • II-III/VI systolic ejection murmur @ LSB.
  • Mid-diastolic murmur heard over LLSB.
28
Q

What causes the systolic & diastolic murmurs of ASD?

A

Systolic murmur is caused by increased flow across the pulmonary valve, NOT THE ASD.

Diastolic murmur is caused by increased flow across the tricupsid valve & this suggest high flow Qp:Qs is 2:1.

29
Q

Is endocarditis prophylaxis required for

ASD?

A

no

30
Q

4 Types of VSD: Most common?

A
  • Perimembranous (or membranous) – Most common.
  • Infundibular (subpulmonary or supracristal VSD) – involves the RV outflow tract.
  • Muscular VSD – can be single or multiple.
  • AVSD – inlet VSD, almost always involves AV valvular abnormalities.
31
Q

VSD leads to?

A
  • elevated RV & pulmonary pressures

- volume hypertrophy of the LA & LV.

32
Q

VSD S/S (3 points)

A
  • II-III/VI harsh holosystolic murmur heard along the LSB, more prominent with small VSD, maybe absent with a very Large VSD.
  • Prominent P2, Diastolic murmur.
  • CHF, FTT, Respiratory infections, exercise intolerance hyperactive precordium. Symptoms develop between 1 – 6 months
33
Q

What genetic disease is AVSD more commonly seen in?

A

Down’s Syndrome (Trisomy 21)

34
Q

look at slide 61

A

.

35
Q

AVSD S/S (6): C-RIFLE + 6

A
  • Congestive heart failure in infancy.
  • Recurrent pulmonary infections.
  • Incomplete AVSD maybe indistinguishable from ASD - usually asymptomatic.
  • Failure to thrive.
  • Late cyanosis from pulmonary vascular disease w/ R to L shunt.
  • Exercise intolerance, easy fatigability.
  • Hyperactive precordium
  • Normal or accentuated 1st hrt sound
  • Wide, fixed splitting of S2
  • Pulmonary systolic ejection murmur w/thrill
  • Holosystolic murmur @ apex w/radiation to axilla
  • Mid-diastolic rumbling murmur @ LSB
  • Marked cardiac enlargement on CX-Ray
36
Q

when is surgery required for AVSD?

A

always

37
Q

narrowing of the aorta at varying points anywhere from the transverse arch to the iliac bifurcation? Most common one? male:female ratio?

A

Coarctation

juxtaductal

3:1

38
Q

What other heart anomaly is coarctation associated with?

A

Bicuspid aortic valve, seen in > 70% of cases

39
Q

What genetic syndrome is coarctation seen in?

A

Turner’s syndrome

40
Q

S/S coarctation of aorta (6):

A
  • diminution or absence of femoral pulses.
  • Higher BP in the upper extremities as compared to the lower extremities.
  • systolic hypertension of the upper extremities.
  • Pulse discrepancy between rt & lt arms
  • II/VI systolic ejection murmur @ LSB.
  • Cardiomegaly, rib notching on X-ray
41
Q

With severe coarctation maintaining the ductus with ___________ is essential

A

prostaglandin E

42
Q

Endocarditis Prophylaxis (4):

A
  • Prosthetic Cardiac Valve
  • Previous infective endocarditis
  • Congenital Heart Disease
  • Cardiac transplantation recipients who develop cardiac valvulopathy
43
Q

Antibiotics Regimens for IE and doses (3):

A
  • Amoxicllin 50mg/kg
  • Ancef or ampicillin 50mkg/kg
  • Clindamycin 20mg/kg
44
Q

Kawasaki disease S/S (5): VCAMM

A
  • Vasculitis
  • Coronary arteries resulting dilation
  • Aneurysm formation
  • MI
  • Mucocutaneous lymph node syndrome
45
Q

Trisomy 21 characteristics (12):

A
  • Smaller than normal for age
  • Short neck, oblique palpebral fissures, small and low set ears, macroglossia, microdonia
  • Mandibular hypoplasia
  • Narrow nasopharynx and hypertrophic lymphatic tissue
  • Generalized hypotonia
  • OSA
  • MR
  • Cervical spine disorders, vertebral instability
  • Thyroid disease
  • sublottic stenosis
  • Large tongue
  • Vascular access can be difficult
46
Q

Trisomy 21 kids can become ___________ under general anesthesia

A

bradycardic

47
Q

Turner’s syndrome S/S (10): X-WASHH-MOLD

A
  • X linked
  • Webbed neck, low set ears, pigmented nevi
  • Aortic coarctation, bicuspid aortic valve
  • Short stature, lymphedema, ovarian failure
  • HTN
  • hypothyroidism
  • Micrognathia
  • Obesity
  • Liver disease
  • DM
48
Q

Williams Syndrome s/s (10): VACANCEE-GM

A
  • Valvular and supravalvular aortic stenosis**
  • Altered neurodevelpment
  • Chromosome 7, deletion in the elastin gene
  • Aortic coarcatation
  • Narrowing of the abdominal aorta and renal arteries
  • Can involve the origin of the coronary arteries
  • Elfin facies
  • Endocrine abnormalities: hypercalcemia, hypothyroidism
  • Growth deficiency
  • MR
49
Q

Williams syndrom: Need ____________________ before anesthesia is administered

A

CARDIAC EVALUATION

50
Q

Leading causes of cardiac arrest in the perioperative cardiac arrest registry for peds is?

A

Williams syndrome

My Peds (6 decks)

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