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260 Cards in this Set

  • Front
  • Back
FEVER
HEADACHE
STIFF NECK
ALTERED MENTAL STATUS

MOST LIKELY DZ
BACTERIAL MENIGITIS
CONFIRM DIAGNOSIS OF MENIGITIS BY
LP
TREATMENT OF MENIGITIS
ANTIBIOTICS
COMPLICATIONS OF MENIGITIS
DEAFNESS
CN PALSIES
HEMIPARESIS
GLOBAL BRAIN INJURY
BRUDZINSKI SIGN IN MENIGITIS
PT SITS UP, PASSIVELY FLEXES NECK THEN AS RESULT KNEES AND HIP FLEX INVOLUNTARILY
KERNIG SIGN IN MENIGITIS
PT SITS UP KNEES AND HIP ARE AT 90 DEGREE ANGLE AND EXTENDS THE LEGS AND GETS PAIN
BRAIN PARENCHYMA IS INFLAMMED
ENCEPHALITIS
LEPTOMENENGEAL INFLAMMED
MENIGITIS
ECOLI
AND
GROUP B STREP (AGALACTIAE)
LISTERIA MOMCYTOGENES CAUSE WHAT MENIGITIS
NEONATAL MENIGITIS
PRETERM BABIES,
LOW BIRTH WEIGHT,
BABIES BORN TO MOMS WITH RUPTURED MEMBRANES AND/OR CHORIOAMNIONITIS, AND BABIES WITH
TRAUMATIC BIRTHING PROCESS ARE AT RISK OF
MENIGITIS
INFANT WITH THERMAL INSTABILITY LIKE HYPOTHERMIA, POOR FEEDING,EMESIS, SEIZURES,IRRITABILITY, APNEA , BULGING FONTENELLE MOST LIKELY DIAGNOSIS
BACTERIAL MENIGITIS
HOW DOES BACTERIAL MENIGITIS SPREAD IN INFANTS
HEMATOGENOUS
STREP PNEUMONIAE AND
NISSERIA MENIGITIDIS CAUSE BACTERIAL MENIGITS IN WHO
OLDER CHILDREN
WHAT BACTERIAL MENIGITIS IN OLDER KIDS THAT IS SEEN LESS DUE TO MORE KIDS GETTING VACCINATIONS
H INFLUENZA B
WHICH BACTERIAL MENIGITS ORGANISM IS ENCAPSULATED AND SEEN MOSTLY IN THE WINTER, ALSO IN BAD WORKING SPLEENS AND ASPLENIC KIDS AND SICKLE CELL KIDS MOORE
PNEUMOCOCCAL
OLDER KIDS WITH MENTAL STATUS CHANGES, NAUSEA, VOMTING, LETHARGY, RESTLESSNESS, ATAXIA, BACK PAIN, KERNIG , BRUDZINSKI, CN PALSIES MOST LIKELY DIAGNOSIS , SEIZURES
BACTERIAL MENIGITS
WHAT ELSE IS SEEN IN NISSERIA MENIGITIDIS
PETECHIAL OR PURPURIC RASH CALLED PURPURA FULMINANS SIGNIFIES SPETICEMIA
WHEN DO YOU NOT USE LP TO CONFIRM DIAGNOSIS
IF THERE IS SKIN INFECTION AT PUCTURE SITE
REASON FOR INCREASE INTRACRAINIAL PRESSURE
CRITICALLY ILL PT THAT MAY DIE FROM PROCEDURE
OTHER TEST TO CONFIRM DIAGNOSIS
GRAM STAIN AND CULTURE
WHITE AND RED BLOOD CELLS
PROTEIN AND GLUCOSE ANALYSIS
BACTERIAL ANTIGEN SCREEN
CAN U PERFORM A BACTERIAL ANTIGEN SCREEN
YES, BECAUSE ANTIGEN STAY IN BLOOD SEVERAL DAYS EVEN WHEN CULTURE IS NEGATIVE
ELEVATED OPENING PRESSURE,
LOT OF WBC WITH A LOT OF PMNS,
ELEVATED PROTIEN,
DECREASED GLUCOSE LEVELS OF THE LP FLUID THINK THIS DISEASE
BACTERIAL MENIGITIS
DECISION ON WHICH DRUG TO GIVE IS BASED ON
CSF GRAM STAIN
FOR NEONATES WITH MENIGITIS GIVE
AMPICILLIN COMBINED WITH THIRD GENERATION CEPHALOSPORIN AND AMINOGYLCOSIDE
TO COVER GROUP B STREP L MONOCYTOGENES, ECOLI
STREP PNEUMONIA AKA PNEUMOCOCCAL MENIGITIS
WHAT DRUG DO WE GIVE
THIRD GENERATION CEPHALOSPORIN COMBINED WITH VANCOMYCIN RECOMMEND
FEVER
NECK STIFFNESS
PAINFUL EATING
FULLNESS OF OROPHARYNX
RETROPHARYNGEAL ABCESS
WHAT TEST FOR RETROPHARYNGEAL ABCESS
LATERAL NECK XRAY
FULL ANTERIOR FONTENELLE WITH OTHER
MENIGITIS WHAT DO YOU DO?
PERFORM LP
BLOOD CULTURE
URINE CULTURE
ADMIT TO THE HOSPITAL
SINUSITIS
PROLONGED HEADACHES
NUCHAL RIGIDITY
VOMITING MOST LIKELY DIAGNOSIS
INTRACRAINIAL ABCESS
CONFIRM DIAGNOSIS OF INTRACRANIAL ABCESS BY
CT WITH CONTRAST
kid lives in old home, or near battery recycling plant or lives with sibling with lead posioning
mld( most likely diagnosis )
lead poisoning
what do you do for screening of lead poisioning
capillary blood stick
what do you do as a confirmation test for lead poisioning
serum venous blood level only if the capillary lead levels are >10
if venous serum lead levels are >10 for lead whats next
counsel parent and recheck in 1 month. try to see if parent can remove child from the home
what do you do if lead levels are >45
chelation therapy with dimercaprol or dimercaptosuccinic acid (DMSA or succimer)
sudden shortness of breath,
low blood pressure(hypotension)
fast HR(tachycardia)
itching (urticaria)
stridor and wheezing(bronchospasms)
with known allergy to food
mld is
allergic reaction to food
anaphylaxis
how do we treat anaphylaxis in a pt that has a open airway
subcutaneous epinephrine injection as long as ventilation is good
what type agonist is epinephrine
a1 and b2
increase hr and relax bronchioles
pt with aggression, acne starts popping up, male pattern baldness all the sudden, gynecomastia what drug do you think of
anabolic steroids
side effects of anabolic steroids
mess with testicles decrease tetes size and sperm count
mess with the liver and get erythrocytosis
hdl decrease (bad)
cardiac problems can form
increase in testosterone convert to estrogen which form girlie breast
skin get messed up and get baldness and acne

women can have virilizationa nd clitoral enlargement
what drug intoxication is this ?
euphoria with agression
psych changes (cognitive impairment and mood disorders)
multiorgan dysfunction
cocaine intox
what intoxication is this?
mild euphoria to stupor to coma
respiratory depression
pupillary constriction
decreased bowel function
heroine intox
what drug intoxication is this ?
htn
tachycardia
sever aggression and aggressiveness
psychosis.
acne and facial sores due to picking
meth intox
what drug intoxication is this ?
breif dissociative psychotic episodes
agressive
unaware of pain
pcp intox
what drug intoxication is this ?

short lived psychotic experiences
hypoxia
brain damage
bone marrow suppression
inhalant intox ( spray paint )
baby with bulging fontenelle
fussy
widely spaced sutures
big scalp viens
poor feeding
vomiting
decreased activity

normal everything else

mld
hydrocephalus - accumulation of csf
ventricles and subarchnoid space working fine but decreased absorption what kind of hydrocephalus
communication hydrocephalus
no communication between subarachnoid and ventricles what kind of hydrocephalus
noncommunication hydrocephalus
what do you check for hydrocephalus
rapid head circumferience growth especially if it is greater than 97th percentile
what diagnostic test do you do for hydrocephalus
ct of head
what treatment exist for hydrocephalus
shunt from ventricles to to peritoneum, pleura, or right atrium
what test do you do for craniosysnostosis
skull radiograph
what test do you do for seizures
eeg
why do you not do lp if you suspect brain tumor or abcess
increased cranial pressure can lead to herniation
kid with fever
new onset of headache
new onset of focal neurologic changes
new onset of siezure
spasticity or
signs of increased cranial pressure(irritable, not feeding well)

mld
brain abcess
what kids are highly likely to develop a brain abcess
kid s with
congenital heart disease
head trauma
infectionf of jaw and mouth
infection of face or scalp
menigitis
cranial instrumentation
what vitamin is given to prevent neural tube defects
folic acid
what prevents hiv moms from passing it to baby
zidovudine and c section
what infection inutero can cause
microcephaly
hepatosplenomegaly
deafness
chorioretinits
thrombocytopenia
TORCH infections
toxoplasmosis other(syphilis) rubella cmv hsv
what can smoking cause to a inutero baby
intrauterine growth retardation
neuro problems
developmental problems
what test do all kids receive between the ages 0-5
vision

testing for

strabismus, amblyopia, refractive errors
when do you give postexposure prophylaxis to kids for rabies
if they have been exposed to saliva or neural tissue of bats, wild carnivores, or an animal that could possibly have rabies
in preterm infants when do you give vaccination
normal chronologically schedule
they are easier to get sick
what is the exception to the rule for given preterm infants vaccinations
dont give hep b if baby is not at least 2kgs
sickle cell concept
insert
what drug do you give sickle cell patient to keep them from having a vasoocclusive crisis and acute chest syndrome
hydroxurea-
it increases fetal hb and dilutes the the number of sickled cells floating around
side effect of hydroxurea
bone marrow suppression so you can see leukopenia, thrombocytopenia, and anemia
what organ removes the sickling cells
spleen
what causes the vasooclusive crisis
microthrombi
what drug is given to sickle pts to decrease encapsulated organisms
penicillin
what process to the sickle cell pts have to go through regularly that can cause iron over load and what do we do to fix the problem
blood transfusions

we fix the iron overload by iron chelators like deferoxamine to reduces the hemosiderosis
sickle cell pt going through crisis what appear on a peripheral blood screen and why
retics becasue bone marrow is trying to fix the problem of the hemolysis of the sickling cells that is going on
what disease can cause childhood strokes
sickle cell disease
how do strokes present in kids
sudden onset clumsy and difficulty walking along with sickle cell symptoms
kid with painful thighs or arms
tenderness of those areas
fever
tachycardia
anxiety that is african american

mld
sickle cell
what test do you do if you suspect sickle cell
cbc
retics
peripheral smear
poor weight gain , length retardation, head circumference sparing
and no other reason why
non organic failure to thrive
when you have failure to thrive
do a complete what next
history gather as much info as possible especially diet
how to evaluate failure to thrive
screen for dietary measures
dietary counseling
frequent office visits to asses weight
growth below the 3rd or 5trh percentile in kids under 5 whose peers are taller
failure to thrive
non organic ftt is due to
poverty
poor care givr -child interaction.
about 1/3 to 1/2 cases of ftt seen in tertiary car is due to nonorganic ftt
mostly all cases seen in primary care are due to these reasons
poor growth becasue of medical conditon like inflammatory bowel disease, renal disease, congenital heart disease is called
organic ftt
reasons kids dont gain weight
1. not getting enough calories- lack of appetite-depressed chronic dz, cant ingest the food-disorders, not able to get food-neglect
2.alter growth potential-prenatal, endocrine, genetic problems
3.calori wasting- emesis,malabsorption,renal problems
4. need more calories due to defect-increased metabolism,
kids nonorganic and renal caused organic tend to what when they are initally ftt
catch up
labs for ftt
cbc
lead level
u/a and culture
lytes + ca, bun, creat
tb or hiv if needed
tx nonorganic ftt by
improved dietary inake
close follow up and
attention to psychosocial issues
when a child is born as a premie, downs syndrome or turners use what to determine normal growth or not
premie growth chart
developmental delay,
iugr(microcephaly)
cataracts,
seizures
hepatomegaly
prolong neonatal juandice
purpura at birth
calcified brain densities in periventricular pattern
congenital cmv
developmental delay,
iugr(microcephaly)
cataracts,
seizures
hepatomegaly
prolong neonatal juandice
purpura at birth
calcified brain densities in scattered pattern in cortex
congenital toxoplasmosis
child is a picky eater between 18-30 months old true or false

what do you do for the parents
true 2-3 years old kids are picky

stop letting kids snack, dont force feed
most common cause or organix ftt
renal tubular acidosis due to bad bicarb reabsorption type 2 or distal tubule defects type 1
kid who previously healthy but has sudden change in behavior at home and at school doing bad, or seems depressed think
1.substance abuse
2. psychiatric - depression mainia or bipolar
how to evaluate drug abuse
complete history,
pe
urine drug screen
screen for common associated drug abuse consequences (std & hepatitis)

its ok to ask these question with the kid patient alone if drug abuse is suspected
tx drug abuse
1. detox
2.f/u with support therapy
3.long term assistance with trained professional
alcohol or other drugs leading to impairment ditress causing filure of school or work obligations, physical harm, substance legal problems, or continued use despite social or interpersonal consequences this is
substance abuse
alcohol or other drugs causing loss of control with use compulsion to get more, and continued use despite persistent or recurrent negative consequences this is
substance dependence
Risk factors for abuse
1. kid with behavior problems
2. kid with learning difficulties
3. kid in messed up family situation
most common legal drugs used by kids
cigarettes
alcohol
most common illiegal drug used by kids
marijuana
clues that kids are doing drugs
1. behavor changes
2. decline in performance at school or work
3. involvemnet witht he law
euphoria
grogginess
impared short memory
talkative
respiratory depression think this drug
alcholol intoxication
how long does alcohol stay in the blood and ruine
blood 7-10 hrs
urine 10-13 hrs

vasodilation also
elation & euphoria
impaired short term memory
distortion of time
poor performance of task the require you to concentrate
loss of judgement
what drug?
weed
how long is weed in the urine
3-10 days for the occassional user
2 months for chronic user
euphoria
increase motor activity
decrease tiredness
dialated pupils
tachycardia
hypertension
hyperthermia
paranoid iease
doctor see in nose of pt nasal mucosa chnges
what drug?
cocaine
how long does coke stay in the urine
2-4 days
euphoria
increase sensory feeling
increase psychic and emotional energy
nausea
teeth grinding
blurred vision
jaw clenching
anxiety
panic attacks
psychosis

what drug?
meth & estacy
how long does meth and estacsy stay in urine
2 days
euphoria
decreased pain sensation
pinpoint pupils
hypothermia
vasodilation
respiratoyr depression
doctors may see needle tracks over viens
what drugs
opiates
1. heroine
2. morphine
3. codiene
how long does opiates stay in the urine
2 days
euphoria
nystagmus
ataxia
emotional lability
hallucinations
disorientation
hypersalivation
abusive language

what drug
pcp
how many days is pcp in the urine
8 days
sedation
pinpoint pupils
hypotension
bradycardia
hypothermia
hyporeflexia with
cns depression and respiratory depression

what drug?
barbs
how long are barbs in the rine
1 day for short acting
2-3 weeks for long acting
life threating tx of drug and alcohol use is
abc

manage airway
control breathing
assess circulation
then treat the actual agent
delusions
body distortion
paranoid
then pt get panicked
symptoms start between 30-60mins after ingestion and peak in 2-4 hours and resolve in 10-12 hours

what drug
lsd
headaches
blurried vision
personality changes
think what dz
brain tumor

do neuroimaging
when doing a uds on an adolescent pt .
who do you ask permission from
the kid
older women has baby with decrease tone, upslanting palpebral fissure, poor moro reflex, brushfield spotsepicathal folds, redundant nuchal sking, fifthfinger clindodacyly and bradydactyly and single palmar crease

what dx
downs syndrome

brushfield spots - white or grey spots on the periphery of the iris
brachydactyly- shortening of fingers and toes

clindactyly- incurving of fifth digit
what is the next step in evaluation of downs syndrome
1.infant chromosome evaluation
2.evaluate to see if pt displays other features of the syndrome
3.counseling and family support
AFP, b hcg, estriol, test to see if a baby has genetic problems is called and done at how many weeks gestation
triple screen + chorioamniotic or chorionic viollous test


done at 15-20 weeks

60% of ds babies are found this way
when ds baby at the actual birth you use
______ before looking for abnormalities
abc of medicine
what cardiac problems do downs pts have.
endocardial cushion defect
vsd
tetrology of fallot
what do you do if your downs pt has a cardiac defect
1. echo
2. consult cardiology
what gi problems to downs pt have
intestinal- doudenal atresia
may have history of polyhydraminios and vomiting after feeding(can be bilious)
what do you do if you suspect doudenal atresia in downs pt
1.upper gi study you could see double bubble pattern
2. Surgury
what is shown on the chromosoamal analysis
extra chromosome 21 because of a nondisjunction which is the failure to segregate during meiosis 95% of the time.
Translocation 2%-removal of one peiece of cx get attached to another peiece of cx
Mosaic3%- more than one cell type
other conditions associated with ds
hearing loss
strabismus
cataracts
nystagmus
congenital hypothyroidism
when do you check hearing and vision in ds baby
3 months for hearing
6months for vision
long term problems of ds babies
leukemia
hypothyroidism
atlantoaxial instability
premature aging
alzheimer
mental retardation some mosiac have near normal intelligence
uri infection for 12-48 hoursa then barky cough, with or without fever, inspiratory stridor, hoarse voice, and mild pharyngitis
croup
treament for croup
cool mist to relieve laryngeal spasms
aerosolized and oral epinephrine

oral and aersoluzed
steriods
avoid in croup patients
tongue blades and needle stick
what makes croup worse
crying and agitation
what to monitor in croup babies
o2 sat
ages that get croup
6mons to 3 year old
in sept thru dec
more boys than girls
what bugs cause croup
parainfluenza
influenza a and b
adenovirus
rsv
what is physio of croup
narrowing airway and subglottic edema
treatment for croup
corticosteroid:dexamethasone .6mg/kg : 1 time works for 2-4 days
observe for 4 hr
no change do the following:
blow by o2, corticosteroid:dexamethasone .6mg/kg
nebulized racemic epi quick working 10-30 mins
heliox if severe
monitor for 2-4 hours after racemic epi
observe for 3-10hr to reduce admission
what is peak rsv season
dec to march
what increase risk of rsv
what decrease risk of rsv
increase passive smoke
decrease breast feeding
pathophysio of rsv
lower respiratory tract infection with inflammation, edema, and necrosis of epithelial cells lining the airway
increase mucus made bronchspasms
rsv can present as
runny nose
tachypnea
accessory muscles used
nasal flaring
grunting
auscultation you here crackeles, cough wheezing
diagnostic studies for rsv
rsvi viral test
pulse oximetry while awake and sleep
if fever or toxic exist
cxr, blood test, urinalysis
treatment for rsv
02,
if dehydrated ivf ,
bulb suction of nose,
hand washing
treatments not recommended
1. albuterol
2. epi nebs
3. corticosteroids
4. antibiotics
5.chest pt
complications of rsv
apnea
2ndary bacterial infections:pneumonia, uti, aom
rsv organisms
rsv,
influenza
adenovirus
parainfluenza
uti are ascending infection what bug causes 80% o infections
1st-ecoli- pill adhere to uroepithelium
2nd- kleb,proteus,enterobacter,citrobacter
3rd-
enterococcus staph sap, stap aureus
fever abdominal or back pain, dysuria, increase frequency, urgency, or incontinence
hematuria, suprapubic tenderness what disease
uti / pylonephritis
test for a uti
u/a and cx midstream clean catch
renal U/S in first timers
lp in kids less than 1mon connection with menigitis
tx for uti in newborns and infants
ampicillian and gentimicin
14day course
7day in cyctitis
3 day in 1st timer older kid
in ill looking uti kids give
3rd generation ccephlosporin
ceftriaxone + gentimicin
if enterococcus consider ampicllin
risk factors for kids with uti
females<4 males<1
parents with childhood uti
female with short urethra
uncircumcised males
voiding dysfunction
(holding it)lot of school age kids and recurrent
vesicourteral reflux -most kids that are febrile
obstruction
sexual activity
pt comes in weeks after a viral infection with drooping mouth on one side. cant close one eye think this dx
bells palsy
treatment for bells palsy
maintain moisture of eye especially at night to prevent keratitis

this resovles spontaneously in 80% of cases
girl with limp and knee joint pain and iridocyclitis in the eye salmon pink rash, fever, serositis (which is pleuritis or pericarditis), increased wbc +ana + rf has what dx
pauciarticular juvenile arthritis
how do you treat juvenile arthritis
nsaids
methotrexate
etanercept or infliximab

goal is to prevent blindness
kid with arthralgias, morning stiffness, butterfly or discoid rash, joints hurt, uvietis or retinitis, decreased wbc, +ana +rf , decreased complement, increased antibodies to ds dns, protienuria(renal dz), seroitis think this dx
sle

most have renal dz with sle

long term complications
avascular necrosis
cardiac athersclerosis
treatment for sle
nsaids
steroids
hydroxchloroquine
immunosuppressive agents
arthalgia, erythema marginatum, polyarticular joint pain, increased aso anti dnase b, carditis, subcutaneous nodules, chorea think
rhumatic fever
rheumatic fever is caused by
group a strep
treatment for rheumatic fever is
penicillin prophylaxis
aspirin
steroids

to help the chorea give barbituates or chlorpromazine
arthralgias, erythema migrans, mono or pauciarticular joint pain, conjunctivitis or keratitis, icrease in cryoglobulin, increase in immune complexes with carditis, neuropathy, or menigitis think this disease
lyme disease
cause of lyme disease
borrelia burgdorferi
treatment for lyme dz
penicillin
doxycycline
ceftriaxone
arthralgia, mono or pauciarticular joint pain, small joint pain, increased wbc or neutropenia+/- blast + bone marrow problem, thrombocytopenia think this dz
leukemia
what causes this type of leukemia in kids
all
treatment for all
steroids
chemotherapy
female older than 12 that has sex and a menses with arthralgia, palms and soles papulopustules, mono or pauciarticular joint pain, increased wbc count, +gc culture,erosive arthritis think this dz
gonococcemia
gonococcemia is caused by
n gonorrhea
tx for gonococcemia
ceftriaxone
kid less than 5 years old with aacute phase arthralgia, sudden high fever, cervical lymphadenopathy, swollen hands and feet, mouth lesions strawberry tongue,diffuse maculopapular rash on inguinal and chest area andlarge and medium joint pain, bilateral conjunctivitis nonsupperative, uveitis, subacute phase desquamation with decrease in fever large , thrombocytosis, increase immune complexes, covalescent phase over by 6-8 weeks think this dz
kawasaki dz
what causes kawasaki
unknown
tx for kawasaki
aspirin
ivig
rare complication of kawasaki
giant coronary artery aneurysm
galactosemia -ar dz- carbohydrate metabolism problem

where is galactose found

what accumulates

what organ get damaged
milk

lactose

liver
furtosemia- ar dz- carb metabolism problem

where is fructose found

what accumulates

what organ does it hurt
fruit juices

fructose and sucrose

liver
tyrosinemia - ar dz

what accumulates

what organs are damaged
tyrosine

liver, cns, kidney especially liver
failure to thrive, hypogylcemia, hepatomegaly, and acidosis in a 3-4month old baby
glucose 6 phosphatase deficiency
infant with cholestatsis, bleeding into cns,gi,or umbilical stump and elevated transaminases think this dz
alpha 1 antitrypsin def
older kid with chronic hepatitis with cirrhosis and portal htn
think this dz
alpha 1 antitrypsin def
babies born to moms with sle can get what complication
heart block
baby with born to a mom with hyperthyroidism is mostlikely to develop
neonatal thyrotoxicosis - TSI cross the placenta but tsh cant. but they thyrotoxicosis goes away in 2-4 month when the tsi diminishes
BABY PRESENTS WITH:
tachycardia,
tachypnea
juandice
hepatosplenomegaly
thrombocytopenia
irritable,
diarrhea
HEART DISEASE
in girls constitutional precocious puberty is usually due to
gonads mature becasue of increase in pituitary gonadotrophin working to make sex steroid to work on the gonads
boys usually have precocious puberty due to
lesion of the cns
How do you close a PDA?
indomethacin, closure surgery
do nothing if pda is keeping them alive like in transposition, hypoplastic left heart, tetrology
How do you keep a PDA open?
PGE 1
PDA is associated with -
Rubella
- high altitudes - low o2 tension
Associated symptoms with PDA
asymtomatic usually
ftt
recurent lower resp infection
lowe extremity clubbing
dyspnea
- possible CHF
pt with wide pulse pressure
continuous machinery murmur at 2nd left intercostal space
loud s2
bounding peripheral pulse think this dz
pda
diagonose pda by
color flow doppler see blood flow from aorta to pulmonary artery
echo and ecg show lv and la enlargement
cxr show cardiomegaly
Holostyolic murmur next to sternum
VSD
True or false: most VSDs resolve on their own?
true
What is the most common congenital heart defect?
VSD
what dz have vsd
cri du chat
downs
trisomies 13 and 18
apert
whats apert
crainal deformities
fusion of fingers
and toes
left to right shunt that is asymptomatic at birth then pt get recurrent repiratory infections, ftt, chf with a pansystolic murmur at kiwer keft sternal border and loud pulmonic s2 think
vsd
diagnose vsd by doing a
echo
tx of vsd
spontaneously closes usually
if large do surgery
for chf symptoms
do the follow
give diuretic, inotropes,acei
treat respiratory infection
before dental or pulmponary procedures do the following in a vsd pt
give prophylaxsis amoxicillin to prevent endocarditis and septic emboli
What heart defect has a right ventricular heave, wide fixed split s2 with increased blood flow to the lungs , systolic ejection murmur at upper left sternal border, easy fatigiblity, frequent resp infecx, ftt
ASD
Treatment of ASDs
No treatment unless very large
What heart defect is asymptomatic until adulthood?
asd
What heart defect often presents with palpitations?
asd
lrge asd lead to
chf
diagonse asd by
echo with color flow doppler shows blood flow between atria , ventricular wall motion, and dilated rght ventricle
ecg shows right axis devitiation with ostium secundum defects
cxr shows cardiomegaly and increase pulmonary vascularture markings
tx asd
spontaneously close
give antibiotic for ostium primum defect to prevent bacterial endocarditis befoer dnetal work
surgical closure if infant has chf to prevent arrythmias, esienmengers, right vent problems
l to r shunt causes pulmonary htn and shunt reverses this is called
eisenmengers syndrome
Upper extremity HTN =
coarctation or aorta
Radiofemoral delay
coarctation or aorta
Systolic murmur heard over mid-upper back ,
coarctation or aorta
Heart defect with rib notching on x-ray
coarctation or aorta
Heart defect associated with Turner syndrome
coarctation
asymptomatic htn in childhood, dysnea on exertion, cludication, epistaxis, headache, systolic p is higher in right arm than left arm, femoral pulses are weak and delayed, here late systolic murmur in left axilla and forceful pulse at apex with lower limb wasting due to decreased blood flow think
coarctation
diagonose coarctation by
cardiac catherization
ecg
echo
color flow doppler
cxr show 3 sign - due to pre and post dilattion of aorta and rib notching -due to flow thru intercostal arteries
tx coarctation by
surgical correction or balloon angioplasty
give endocarditis prophylaxsis
pulmoary and systemic flow exist in parallel, the aorta is connected to right ventricle, the pulonary artery is conntecte to left ventricle what dz is this
transposition of great vessels
without two defects tga babies can not live after birth what are they
septal defect
pda
very ill baby that is cyanotic right after birth, tachypnea, progressive repiratory failure then dies think
tga
diagnose tga
echo
cxr shows narrow heart base, no pulmonary artery part so it looks egg shaped
tx of tga
if pt has pda keep it open with prostaglandin e 1
baloon atrial septomy
surgical correction
most common cyanotic heart dz in infancy
transposition
most common cyantotic heart dz in childhood
tetraolgy
The 4 anomalies of tetrology of fallot Most common cyanotic
Kids who squart after exertion likely have tetrology of fallow
1. VSD
2. Right ventricular hypertrophy
3. pulmonary stenosis
4. overriding aorta
prov
Kids who squart after exertion to increase systemic vascular resistance during tet spells, hypoxema, ftt, mental status changes,systolic ejection murmur on left sternal border,right ventricular lift,sing s2 think this dz
tetrology
dx tetrology of fallot
echo and catherization
cxr boot shaped heart
ecg show right deviation and rvh
tx tetrology of fallot
pge1 to keep pda open
treat cyanosis with
02 propanolol , knee cheast position, fluids, morphine
temporary palliation with artifical shunt before true surgery
vomiting
sinus bradycardia, wondering pacemaker,parxysmal tachycardia,heart rate of less thant 100bpm what drug has the baby ingested too much of
digoxin
kid with swelling of hands and feet comes and goes, with or without gi problems or laryngeal swelling think
heriditary angioedema (ad)
pathophys of hereditary angioedema
first step in complement cascade messed up sp increase vasoactive kinin
marfans is assciated to what heart dz
dilation of aorta
mr
ar
ellis van crevald syndrome associated to what heart dz
atrial septal defects
pulse rate greater than 250 bpm in a kid think
tachyarrymia like wolf parkinson white
EKG finding of Wolff-Parkinson-White syndrome
delta wave
What causes symptoms in Wolff-Parkinson-White syndrome?
Transient arrhythmias conducted on accessory pathways
tricuspid regurg murmur and mid diastolic murmur at the lower left sternum with right atrial hypertrophy and right ventricular conduction problems think
ebstein anomaly
tricuspid atresia shows what on cxr
left axis deviation and lvh
early cyanosis, decreased pulmonary arterial blood flow, left axis deviation, lvh think
tricuspid atresia
fluffy snowman shape from venous congestion, with obstruction of pulmonary venous return, think
total anomoly of venous return
pt with apical murmur in late systole preceded by click think
mitral valve prolapse that the valve billow in the atria at the end of systole
dx mitral valvle prolapse
echo show prolapse
ecg and cxr normal
tx mitral valve prolaspe
use antiboittic to prevent endocarditis
Teenager with sudden cardiac death =
What triggers closure of the ductus arteriosis? increased O2 shuts off prostaglandin production
hypertrophic obstructive cardiomyopathy
Treatment of hypertrophic obstructive cardiomyopathy -
B-blockers
- consider pacemaker placement
Where is fetal circulation O2 highest?
Umbilical vein
Where is fetal circulation O2 lowest?
Umbilical artery
In fetus, which has highest O2 content, blood to arms or legs?
Blood to arms
Resting HR over 100 is normal up to age 10 years
Medications that are contraindicated in obstructive hypertrophic cardiomyopathy -
positive ionotropes
- diuretics
- vasodilators
How does the foramen ovale close?
Increase in left-side heart pressures Heart pressure changes at time of birth - 1st breaths cause lung inflation and decreased pulmonary vascular resistance
--> increased arterial flow --> increase left sided pressures
What triggers closure of the ductus arteriosis?
increased O2 shuts off prostaglandin production
vaccinations given at birth
hep b
vaccinations given at 1 month
vaccinations given at 1 month hep b, only if not given at birth
vaccinations given at 2 months
vaccinations given at 2 months Pediarix (HBV, DTaP, IPV)
Prevnar (pneumococc)
Rotavirus
Hib
what is in pediarix
what is in pediarix HBV
DTaP
IPV
vaccinations given at 4 months
vaccinations given at 4 months Pediarix
Prevnar
Hib
Rotavirus
vaccinations given at 6 months
vaccinations given at 6 months Pediarix
Prevnar
Hib
Rotavirus
vaccinations given at 12 months
vaccinations given at 12 months DTaP
Hib
MMR
VZV
Prevnar
Influenza
Hep A
vaccinations given at 24 months
vaccinations given at 24 months none
vaccinations given at 4-6 yrs
vaccinations given at 4-6 yrs DTaP
IPV
MMR
Influenza
vaccinations given at 11 yo
vaccinations given at 11 yo Tdap
Meningococcus vaccine
what is the schedule for well visits starting from birth 1 mo
2 mo
4 mo
6 mo
9 mo
12 mo
15 mo
18 mo
24 mo
then annually
why shouldn't babies drink water because their kidneys aren't mature enough to handle the extra fluid so the babies will become hyponatremic since they can't excrete the water, and then they can have szs
plagylocephaly mishapen head
sunsetting sign increased icp, eyes are half closed 2ndary to the increased icp on the cranial nerves
craniosynostosis premature closure of the fontanelles
rash pattern in rmsf palms and soles, then spreads to trunk

petechial
rash pattern in rubella rash on face that spreads to the rest of the body
rash pattern in measles rash starts at the head and spreads downwards and disappears in the same manner
rash pattern for erythema infectiosum slapped cheek rash; lacy, reticular
vzv rash pattern begins on trunk, followed by head, face, and extremities
gross motor skills at 1 mo old raises head
gross motor skills at 3 mo holds head up
gross motor skills at 4-5 mo rolls front to back and back/front
sits supported
gross motor skills at 6 mo sits unsupported
gross motor skills at 9 mo crawls
cruises
pulls to stand
gross motor skills at 12 mo walks alone
gross motor skills at 15 mo walks backwards
gross motor skills at 18 mo runs
gross motor skills at 24 mo walks well up and down stairs
gross motor skills at 3 yrs rides tricycle
throws ball overhand
gross motor skills at 4 yo alternates feet going down stairs
skips
fine motor skills at 1 mo follows eyes to midline
fine motor skills at 3 mo hands open at rest
fine motor skills at 4-5 mo grasps with both hands together
fine motor skills at 6 mo transfers hand to hand, reaches with either hand
fine motor skills at 9 mo pincher grasp
finger feeds
fine motor skills at 12 mo throws, releases objects
fine motor skills at 15 mo builds 2 block tower
fine motor skills at 18 mo feeds self with utensils
fine motor skills at 24 mo removes clothing
builds 5 block tower
fine motor skills at 3 yrs draws circle
fine motor skills at 4 yrs catches ball
dresses alone
fine motor skills at 5 yrs ties shoes
Simple febrile sz btwn 6mo - 6yr
tonic clonic
associated with fever >100.4
sz lasts <15 mins
only 1 sz in 24 hrs
minimal post-ictal state
complex febrile sz 6 mo - 6 yrs
focal sz
>15 mins
>1 sz/24 hrs
management of simple febrile sz determine the source of the fever, otherwise, no other w/u is needed
management of complex febrile sz full w/u should be done, but no anti-epileptics, no eeg needed
if pt is <18 mo, LP
eeg abnormality associated with infantile spasm hypsarrythmia
definition of recurrent abdominal pain >3x in 3 mo
#1 cause of abdominal pain gastroenteritis
what is the schedule for well visits starting from birth 1 mo
2 mo
4 mo
6 mo
9 mo
12 mo
15 mo
18 mo
24 mo
then annually