Section 12: Tintinalli: Pediatrics: 122 -

Front 1

Cyanotic pediatric cardiac diseases include the 5 "T's". Name them.

Back 1

Tetrology of fallot
Transposition of the great vessels
Total anomalous pulmonary venous return
Tricuspid anomalies including tricuspid atresia
Truncus arteriosus

Front 2

Acyanotic pediatric cardiac diseases include what 4 diseases? 3 Acyanotic duct dependent cardiac disease?

Back 2

ASD
VSD
PDA
Atrioventricular canal

Hypoplastic left heart syndrome
Aortic stenosis
Coarctation

Front 3

How do neonates and infants increase cardiac output?

CO = SV x HR

Back 3

Increases in HR, their ventricles are relatively non-compliant and they can't increase SV very much.

Front 4

What cardiac problems eventually lead to Eisenmenger complex? What is the physiology behind it?

Back 4

VSD, ASD

Chronic left to right shunting leads to hypertropy of pulmonary artery than eventually becomes a right to left shunt producing cyanosis.

Front 5

What are the 4 components of tetrology of fallot?

Back 5

1) Large VSD
2) Right ventricular outflow obstruction
3) Overriding aorta
4) RVH

Front 6

What must be present in transposition of the great arteries for a fetus to be viable?

Back 6

A large VSD, ASD, or PDA

Front 7

What is the basic problem in total anomalous pulmonary venous return?

Back 7

Pulmonary veins bring oxygen rich blood back to the right atrium instead of the left atrium

Front 8

What is the basic problem in tricuspid atresia?

Back 8

There is no tricuspid valve and the development of the right ventricle and right pulmonary artery is interrupted, this results in decreased pulmonary blood flow.

Front 9

DiGeorge syndrome is associated with which of the 5 cyanotic cardiac disease?

Back 9

Truncus arteriosus

Tetrology of fallot
Transposition of the great vessels
Total anomalous pulmonary venous return
Tricuspid anomalies including tricuspid atresia

Front 10

Describe the hypoxia test in determining if a child has a cyanotic heart defect?

Back 10

Neonates on 100% should be able to increase PO2 by > 20 mm, however, if a cyanotic lesion is present, they will not be able to do so due to right to left shunting.

Front 11

Why can neonates tolerate oxygen saturations in the 70's and 80's without tissue or brain hypoxia?

Back 11

They have oxygen avid fetal hemoglobin and can tolerate it.

Front 12

Why don't you want to give oxygen to a neonate with possible cyanotic heart disease if it is not absolutely necessary?

Back 12

Oxygen is a vasodilator and can vasodilitate the pulmonary vasculature "stealing" from a PDA. Oxygen should be reserved for patients with signs of inadequate tissue perfusion, those with known heart disease, those in whom it might be diagnostic.

Front 13

In what situations can providing oxygen to a cyanotic child with cardiac disease be beneficial.

Back 13

Due to oxygen being a vasodilitator, it can help in pulmonary hypertension and other vasoconstricting syndromes. It should not be given to children who are dependent on a PDA who are showing signs of tissue hypoxia.

It may also close a PDA.

Front 14

What is a "tet spell" and what disease is it associated with?

Back 14

A tet spell is caused by a right sided outflow tract obstruction causing a right to left shunt. Hypoxia and acidosis cause further pulmonary vasoconstriction creating more R to L shunting.

Tetrology of fallot

Front 15

What is the treatment for tet spells?

Back 15

100% oxygen
calming
increasing preload and afterload to decrease R to L sunting.
Flexing knees to chest to increase venous return and increase systemic vascular resistance

Next treatments include morphine, fluid, sodium bicarb (decrease pulmonary spasm), propranolol

Front 16

Decreased pulses in the lower extremities are associated with what disease?

Back 16

Coarctation of the aorta

It is PDA dependent and may present at shock.

Front 17

Name 3 acyanotic lesions that present as shock?

Back 17

Hypoplastic left heart syndrome
Aortic stenosis
Coarctation

Front 18

How can you use pulse oximetry to determine whether you have a duct dependent problem?

Back 18

Pre-dulctal R upper extremity
Post-ductal L upper extremity

May reveal a difference suggesting duct dependent lesion.

Front 19

A single heart sound is associated with what acyanotic heart disease?

Back 19

hypoplastic left heart syndrome

Front 20

What is the single most important medical intervention for duct dependent cardiac diseases?

Back 20

Prostaglandin PGE1

Front 21

When do infants with CHF present (how many months old)? What symptoms do they have?

Back 21

2-4 months

Failure to thrive
Feeding difficulties
Sweating with feeds
Gradually increasing respiratory distress

Front 22

Endocardial cushion defects are associated with what congenital condition?

Back 22

Down Syndrome

Front 23

What are the signs of Kawasaki disease?

Back 23

1) fever for >5 days
2) bilateral conjunctivitis
3) lymphadenopathy
4) erythema of mucous membranes
5) Rash
6) Extremity changes

Front 24

What are potential cardiac complications of Kawasaki disease?

Back 24

Coronary aneurysm: 15-25% if untreated by 3-4 weeks
myocarditis 0-2 weeks
pericarditis 0-2 weeks
pericardial effusion
valvular dysfunction
arrhythmia

Front 25

What medications are used in treating Kawasaki disease?

Back 25

IVIG 2g/kg over 12 hours
High dose aspirin (20-25 mg/kg/dose every 6 hours)

Front 26

What are some organisms commonly associated with endocarditis? Following dental procedure?

Back 26

Strep viridans, staph aureus, strep pneumoniae, coagulase negative staph (epidermidis), HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, and Kingella).

Front 27

What are some skin findings in endocarditis?

Back 27

splinter hemorrhages of naile beds
Painless erythematous macules on the palms or soles (Janeway lesions)
Tender subcutaneous nodules on the fingers (osler nodes)

Front 28

What are the 3 groups of cardiomyopathy?

Back 28

Dilated
Restrictive
Hypertrophic

Front 29

Hypertrophic cardiomyopathy is usually genetic in origin and transmitted in what inheritance pattern?

How will a murmur with cardiomypathy change with valsalva?

Back 29

Autosomal dominant

Murmur will decrease with an increase in preload or decrease in afterload. Standing will increase the murmur.

Front 30

What are viral causes of diarrhea in the pediatric population?

Back 30

Rotavirus, norwalk virus, enteroviruses, astrovirus, adenovirus

Front 31

Bacterial causes of diarrhea?

Back 31

Salmonella, shigella, yersinia, camplybacter, e coli, vibrio cholera, c diff

Front 32

Billious vomiting should raise suspicion for what kind of disease process?

Back 32

Obstructive lesion

Volvulus, hirschsprung disease, meconium ileus, imperforate anus, incarcerated hernia

Front 33

What is the amount of replacement of fluids per kg per hour when using the oral replacement therapy in treating diarrhea and dehydration?

Back 33

1 oz (30 ml) / kg / hour

Front 34

What medications should be avoided in treating children with nausea and vomiting? What medication is safe?

Back 34

Dopamine receptor agonists: promethazine, prochlorperazine, metoclopramine, droperidol: Extrapyramidal symptoms and respiratory depression.

Zofran is safe.

Front 35

Which of the following treatments for diarrhea can be considered in children?

Loperamide (immodium)
Bismuth
Probiotics
Zinc

Back 35

Loperamide (immodium) - NO! lethargy, paralytic ileus, death. Possible increased risk of HUS when used to treat EHEC.
Bismuth - No. Increase salicylate levels
Probiotics - Yes?
Zinc - Yes. Benefit unknown in developed countries.

Front 36

Antibiotics should be given to treat which of the following: Shigella, Salmonella, camplobacter, E coli 0157H7, enterinvasive e coli?

Back 36

Shigella: Yes
Salmonella: No, unless sickle cell or immunodeficiency
Camplobacter: Yes
E coli O157H7: No, increases hemolytic uremic syndrome
Other type of E Coli: Yes, if severe.

Front 37

Which antibiotics are most frequently implicated in C diff. diarrhea? What is the treatment for C. Diff?

Back 37

Clindamycin
Cephalosporins
Penicillins

Metronidazole (Flagyl). Another option is oral vanco, but it is more expensive.

Front 38

What are some basic positioning and feeding techniques that you can discuss with parents of children with gastroesophageal reflux?

Back 38

Head elevated position
Thickened, more frequent feedings

Front 39

What is the usual lead point or inciting problem in intussusception?

Back 39

Hypertrophied peyer patch

Front 40

What 2 parasites are most likely to cause diarrhea?

Back 40

Giardia
cryptosporidium