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STEP 2
PEDS - Cardio/GI
| Question | Answer |
|---|---|
| What is considered an innocent murmur? | Systolic murmur or <2/6 in intensity |
| What is the most common congenital heart disease in infancy? | Transposition of Great vessels |
| What is the MC congenital heart disease in childhood? | Tetralogy of Fallot |
| What is main risk factor associated with TGV? | Infant of diabetic mother |
| What is the initial Si/Sx of TGV infant? | Severe cyanosis immediately after delivery |
| How is Dx of TGV made? | 1. ± single, loud S2 murmur 2. CXR- "egg on string" appearance |
| CXR--- "egg on string" DX? | Transposition of Great Vessels |
| What is the initial treatment for TGV? | PGE1 to maintain PDA open |
| What is the definitive treatment for TGV? | Surgery |
| "boot-shaped heart" on CXR. DX? | Tetralogy of Fallot |
| What are the 4 main defects in ToF? | 1. Pulmonary stenosis 2. RV-hypertrophy 3. Overriding aorta 4. VSD |
| What action by the child relieves the symptoms of ToF? | Squatting |
| How does a neonate with ToF present clinically? | Irritability, cyanosis that occurs with exercising and relieves with squatting. |
| How does squatting relieve symptoms in ToF? | ↑ SVR --> ↑↑ pulmonary blood flow --> improve hypoxia |
| How are the heart auscultation findings of ToF described? | Systolic thrill head along the LSB |
| What is the treatment for ToF? | 1. Place patient in knee-to-chest position 2. give Oxygen 3. ß-blocker, 4. PGE1 5. Surgical repair 4-12 months |
| What is the MC congenital heart defect? | VSD |
| What are the main R/Fs for VSD? | Fetal alcohol syndrome, TORCH syndrome, and trisomy 13, 18, and 21. |
| Physical exam for VSD: | Harsh holosystolic murmur over the LLSB + loud pulmonic S2 murmur |
| Holosystolic murmur at the LLSB + loud pulmonic S2 murmur. Dx? | VSD |
| CXR findings of VSD? | ↑↑↑ vascular markings |
| Echo findings of VSD? | Normal heart with small VSD defects and RVH or large VSD defects with LVH |
| Echo findings show small VSD: | RVH |
| Echo findings show: large VSD: | LVH |
| By what age (months) are most VSD often closed? | 6 months |
| What indications to surgically repair VSD before the age of 6 months? | Patient develops pulmonary HTN, shunt is >2:1, or failure to thrive |
| What are complications of VSD in children? | CHF, IE, pulmonary HTN, FtT. |
| Which affects the lungs more, VSD or ASD? | ASD |
| What are the types of ASD? | Ostium primary and Ostium secundum |
| Which ASD type is most common? | Ostium secundum |
| What are findings of ASD physical exam? | Loud S1, wide fixed-split of S2 with systolic murmur |
| CXR: ↑ pulmonary markings and cardiomegaly. Dx? | VSD |
| ASD is associated with loud S1 or loud S2? | Loud S1 |
| VSD is associated with loud S1 or loud pulmonic S2? | Loud pulmonic S2 |
| By what age is an ASD expected to close spontaneously? | Age 4 years |
| What are complications of symptomatic ASD? | Pulmonary HTN, MVP, and dysrhythmia |
| Narrowing of the aorta. Dx? | Coarctation of the aorta |
| Which vessel is the most commonly associated with CoA origin? | Left subclavian artery |
| What are common R/Fs for CoA? | Turner syndrome, bicuspid aortic valve, PDA. |
| What are Si/Sx of severe CoA? | Irritability, heavy sweating, and difficulty breathing |
| What are the main findings of the CoA physical exam? | 1. Pink upper body and blue lower body 2. BP higher in arms than legs |
| What are the featured CXR findings of CoA? | "rib notching" |
| What procedure provides definitive diagnosis of CoA? | Cardiac catheterization |
| What is the initial step in TX of CoA? | PGE1 to keep PDA open |
| What is the MC PGE1 analogue used to keep PDA open? | Alprostadil |
| What is the definite treatment of CoA? | Surgery |
| Which vessels are connected by the PDA? | Left pulmonary artery and aorta |
| PDA in utero allows to: | Bypass the fetus lungs |
| What are the main R/F for PDA? | Female gender, congenital RUBELLA, and prematurity |
| What are symptoms of severe PDA? | Poor eating habits, SOB, poor growth, rapid pulse |
| PDA auscultation is described as: | Machinery-like, to-and-fro murmur |
| What are common physical exam findings of PDA? | Machine-like murmur, wide pulse pressure, and bounding arterial pulses |
| What is the best initial treatment in term neonate with no cyanosis and a PDA? | Indomethacin |
| Blocks prostaglandins production | Indomethacin |
| When is surgery required to correct a PDA? | If Indomethacin is ineffective or the pt is >6-8 months old |
| What the common Endocardial cushion defects? | VSD (MC), ASD, and AV valve insufficiencies |
| What is the most common cause/association for Endocardial cushion defects? | Down syndrome |
| What is the CXR finding of a Endocardial cushion defect? | Cardiomegaly |
| What the treatment for endocardial cushion defect? | Surgery before pulmonary HTN develops |
| What is the significant type of pulse seen in HOCM? | Pulsus bisferiens |
| Which are the diastolic rumble murmurs? | MS and TS |
| Which are the 3 holosystolic murmurs? | MR, TR, and VSD |
| S1 is due to: | Closure of the Mitral and Tricuspid valves |
| S2 is due to: | Closure of the Aortic and Pulmonic valves |
| Which trinucleotide condition is associated with HOCM? | Friederich's ataxia |
| How is the Dx of childhood HTN made? | BP>95% on 2 separate occasions |
| What are common causes of HTN in children? | Renal disease, coarctation of aorta, and endocrine disorder |
| What the MCC of HTN in an adolescents? | Essential HTN |
| Mgmt. of child HTN with renal disease? | ACE-inhibitors |
| Mgmt. of child HNT in obese pt? | Weigh loss, exercise, and diet modification |
| What is the best initial pharmacologic treatment of childhood hypertension? | ß-blockers (↓HR) and diuretics (pee it out) |
| In case ß-blockers and diuretics are not enough for treating childhood HTN, then add: | Calcium channel blocker |
| What is the initial treatment of adolescents HTN? | ACE-inhibitors and Calcium channel blocker |
| How is a calcium channel blocker help in treating HTN? | ↓ contractility of the heart |
| What do tall P-waves indicate on EKG? | Right Atrium enlargement |
| What does Left-axis deviation on EKG indicate? | Left-sided volume overload |
| No communication btw right heart chambers. Dx? | Tricuspid atresia |
| Is Tricuspid atresia seen with CXR with ↑ or ↓ pulmonary markings? | ↓↓ pulmonary markings due to hypoplasia of RV and pulmonary outflow tract. |
| What are the 3 main newborn abdominal malformations? | Omphalocele, Gastroschisis, and Umbilical hernia |
| What is the deficit in Omphalocele? | Failure of lateral walls to migrate at umbilical ring |
| What is the deficient of Gastroschisis? | Extrusion of abdominal contes through the abdominal folds |
| What is the pathogenesis of Umbilical hernia? | Failure of umbilical ring to close after physiologic herniation of the midgut |
| What is the treatment for Omphalocele and Gastroschisis? | Surgical repair |
| What is the treatment of an Umbilical hernia? | None, most close spontaneously |
| Which is covered, Omphalocele or Gastroschisis? | Omphalocele |
| Intestine and Abd organs protrude through the umbilicus. DX? | Omphalocele |
| What genetic conditions are most associated with Omphalocele? | Trisomy 13, 18 and Beckwith-Wiedman syndrome |
| Intestine and abdominal contents protruding lateral to midline. DX? | Gastroschisis |
| Which is not covered, Gastroschisis or Omphalocele? | Gastroschisis |
| What hormonal condition is highly associated with an Umbilical hernia? | Hypothyroidism |
| Outward bulging of abdominal organs through the area AROUND the belly button. DX? | Umbilical hernia |
| What is the next best step in management in newborn with an umbilical hernia? | Check thyroid levels |
| What population is affected by Necrotizing enterocolitis? | Premature infants |
| Premature newborn condition in which portion of bowel undergoes inflammation and necrosis. DX? | Necrotizing enterocolitis |
| What are the Si/Sx of Necrotizing enterocolitis? | Apnea, abdominal distension, bloody stool, F, and lethargy |
| At what time is Necrotizing enterocolitis most commonly presented? | Within the first 2 wks. of life |
| Premature baby + abdominal distension, + bloody stool with first feeding. DX? | Necrotizing enterocolitis |
| What is the key abdominal x-ray finding in Necrotizing enterocolitis? | Pneumatosis intestinalis |
| What are the initial treatment for necrotizing enterocolitis? | 1st - stop feeding 2nd --> decompress the gut by inserting NG tube int he stomach 3rd --> IV antibiotics |
| What is the definitive treatment for necrotizing enterocolitis? | Surgical removal of necrotic bowel |
| If have to decide btw diagnostic testing or stop feedings in Necrotizing enterocolitis, choose: | Stop all the feedings |
| What is Meconium? | First stool (very thick and sticky) |
| Which part of the small intestine is most likely to be affected by meconium ileus? | Ileum |
| What condition is most likely associated with Meconium ileus? | Cystic fibrosis |
| What are the Si/Sx of Meconium ileus? | Abd distension, bilious vomit, and no passage of the 1st stool |
| Waht is the best initial DX test for Meconium ileus? | Abd x-ray |
| What is the treatment for Meconium ileus? | Gastrografin enema |
| What is a Meconium plug? | Functional colonic obstruction in a newborn |
| What are conditions associated with Meconium plug? | Hirschsprung disease Cystic fibrosis Maternal opioid use Small left colon in infant of DM mother |
| What anatomic clue is provided by "bilious vomit"? | Happens after the doudenum |
| What is the treatment for Meconium plug and Meconium ileus? | Gastrografin enema |
| What is Hirschsprung disease? | Congenital defect in nerve fibers of distal bowel --> improper peristalsis and obstruction in the bowel |
| What are the main Si/Sx of Hirschsprung disease? | Failure to pass meconium shortly after birth, Failure to pass stool in first 48 hours of life |
| How are diagnostic tests/exams for Hirschsprung disease? | 1. Rectal exam --> patent anus 2. AXR--> Distended bowel loop with no air in rectum 3. Barium enema --> megacolon proximal to obstruction |
| What is the most accurate Hirschsprung disease diagnostic test? | Rectal suction biopsy |
| What is the TX of Hirschsprung disease? | Surgical resection of aganglionic colon |
| What is an imperforate anus? | Congenital defect in which opening of anus is blocked or missing |
| What are the Si/Sx of imperforated anus? | Failure to pass stool in first 48 hrs. of life |
| Dx for Imperforated anus? | Rectal exam shows imperforated anus |
| Tx for imperforate anus? | Surgery |
| Imperforate anus shares the same symptoms as which other congenital neonate condition? | Hirschsprung disease |
| Which condition is seen with the "triple bubble" sign? | Jejunal atresia |
| What are risk factors for Jejunal atresia? | Cocaine and tobacco use |
| What is seen on abdominal x-ray of Jejunal atresia? | Triple bubble sign and gasless colon |
| What is duodenal atresia? | Congenital condition in with the duodenum is partially/completely blocked |
| What are Si/Sx of duodenal atresia? | Bilous (greenish) vomiting, upper abdominal swelling, absent bowel movement AFTER few meconium stool |
| How is the DX of duodenal atresia made? | AXR--> air in the stomach and 1st part of duodenum --> DOUBLE bubble sign |
| Which condition has the "double bubble" sign on AXR? | Duodenal atresia |
| What is the initial TX for duodenal atresia? | Place NG tube to decompress stomach, IV flid and electrolytes replacement |
| What is the definite TX of duodenal atresia? | Surgery |
| What is intussusception? | Part of the small intestine slides into another leading to a bowel obstruction (lead point) |
| How is the bowel obstruction caused by intussusception called? | Lead point |
| What movement is often seen in patient with intussusception while ongoing episode? | Drawing knees up to the chest |
| How is the stool described in intussusception? | Currant jelly stool |
| What are common risk factors for Intussusception? | Infection/vaccine for rotavirus, Meckel's diverticulum, intestinal lymphoma, HSP |
| Which vaccine is associated adverse effect is intussusception? | Rotavirus |
| What vasculitis is often associated with intussusception? | HSP |
| What diverticulum is often associated with intussusception? | Meckel's diverticulum |
| What is the physical exam finding of intussuscepton? | Sausage shaped mass in RLQ |
| What is the sign often seen in U/S in intussusception? | Target sign |
| What procedure is diagnostic and therapeutic for Intussusception? | Air enema |
| What is the objective of surgery in intussusception? | Remove the lead point |
| Prior to surgery and/or air enema, what is the initial treatment for intussusception? | IV fluid and electrolytes |
| What is intestinal malrotation? | Congenital anomaly in which intestine is incompletely rotated around the SMA |
| What are Si/Sx of intestinal malrotation? | Bilous vomit, bloody diarrhea, F, ↓ appetite, lethargy |
| What is the best initial diagnostic test for Intestinal malrotation? | Ultrasound |
| What is the 2nd best option diagnostic test for intestinal malrotation? | Abdominal x-ray |
| After IV fluids/electrolytes, what is the definitive treatment for Intestinal Malrotation? | Surgery |
| What is the pylorus? | Opening of the stomach into the small intestine |
| What is pylorus stenosis? | Narrowing of the pylorus |
| What is the result of pylorus stenosis? | Prevent stomach from emptying into the small intestine |
| What cases pyloric stenosis? | Hypertrophy often pyloric sphincter |
| What are Si/Sx or Pyloric stenosis? | Non-bilious projectile vomiting after feeding |
| How long after birth is Pyloric stenosis often presented? | ~6weeks after birth (2wks-->4 months) |
| What is the physical exam finding of Pyloric stenosis? | Olive-shaped epigastric mass |
| What are the symptoms due to vomiting and refusal to eat in pyloric stenosis? | Persistent dehydration and weight loss |
| What are the labs of Pyloric stenosis? | Hypo-chloremic hypokalemic metabolic alkalosis due to persistent vomiting |
| What is the finding of Pylorus stenosis by Ultrasound? | "target-like" cross section in the abdomen |
| Initial treatment for Pyloric stenosis: | IV fluids and electrolytes due to hypoCl-, hypoK+, metabolic alkalosis |
| What is the definitive care for Pyloric stenosis? | Pyloromyotomy |
| What antibiotic use ↑↑ risk of developing Pyloric stenosis? | Oral Erythromycin |
| Bilous vomiting only --> | Duodenal atresia |
| Bilious vomiting + bloody diarrhea --> | Malrotation/volvulus |
| Non-bilious vomiting --> | Pyloric stenosis |
| What is Meckel's diverticulum? | Only true congenital diverticulum in the small intestine |
| Meckel's diverticulum is a remnant of what structure? | Omphalomesenteric duct (AKA --> vitelline duct or yolk stalk) |
| What kind of allergy is seen with Meckel's diverticulum patients? | Yolk (egg) allergy |
| What dietary restrictions are to be advised to parents to child with Meckel's diverticulum? | Avoid/eliminate dairy and soy products from diet |
| What are the main complications of Meckel's diverticulum? | Intussusception, Volvulus, and intestinal obstructionn |
| What 2 types of ectopic tissue are found in Meckel's diverticulum? | Pancreatic and gastric |
| What is the MC symptoms in symptomatic Meckel's diverticulum? | Painless rectal bleeding |
| Child with painless rectal bleeding. DX? | Meckel's diverticulum |
| How is DX made for Meckel's diverticulum? | Tc-99 pertechnetate scan (AKA radionucleotide scan) |
| What is the definitive treatment for Meckel's? | Surgical resection of diverticulum |
| What syndrome is associated with infant GERD? | Sandifer syndrome |
| What are the MC Si/Sx of infantile GERD? | Infant spits up after feeding (± apnea after feeding) |
| In case clinical diagnosis is insufficient to dx infantile GERD, what is the next best option? | Esophageal pH monitoring |
| What is the initial treatment of GERD in infant? | Small and frequent thick feeds |
| In case small and frequent thick feeds result not enough for GERD in infant what are the next step in management? | H2 blockers, then PPIs, and last resort fundoplication |
| What is the MCC of constipation in child? | Voluntary withholding |
| What are findings of physical exam in child with constipation? | Large volume of stool palpated in the cecum/suprapubic area |
| What is the finding of a rectal exam in child with constipation? | Rectal vault filled with stool |
| What is the treatment for child constipation? | Initially manual stool disimpactation, and then diet modification and mild laxatives |
| What is the MC trigger for Eosinophilic esophagitis? | Food allergens |
| How is Eosinophilic esophagitis presented? | Dysphagia, epigastric pain, V, and food impactation |
| What is often in the skin seen with Eosinophilic esophagitis? | Eczema |
| What is the MCC of viral diarrhea in children? | Rotavirus (if unvaccinated) |
| What is the MCC of chronic diarrhea in children? | Drinking excessive fluids |
| How is chronic diarrhea presented in children? | Normal height, with and normal stool, but chronic diarrhea. |
| What is Sandifer syndrome? | Type of movement disorder that constitutes paroxysmal spasms of head, neck, and back arching but spares the limbs |
Created by:
rakomi
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