59 terms

Peds II (set 3)


Terms in this set (...)

Characteristics of functional (innocent) murmurs
30% of children, grade 2 or less, systolic, normal split S2, asymptomatic
Still's (vibratory) murmur
functional (innocent) murmur: vibrations from ventricular or mitral structures due to ventricular flow
Peripheral pulmonary stenosis murmur
functional (innocent) murmur: turbulance where main pulmonary artery branches into left & right
Venous hum murmur
functional (innocent) murmur: turbulant flow in superior vena cava and jugular veins (continuous)
Most common congenital structural anomaly
Congenital heart lesions: ASD, VSD, PDA, coarctation, ToF, etc
Atrial Septal Defect ASD
most often ostium secundum, often asymptomatic, most self-resolve, wide split S2, grade 1-3 systolic ejection murmur at Lt base (pulmonic)
Ventricular Septal Defect VSD
Most common lesion (30%), most often perimembranous, most sel-resolve, grade 2-4 holosystolic murmur at LLSB
Patent Ductus Arteriosus
persistance of fetal ductus from pulmonary artery to aorta, usually resolve in first few days of life, continuous "machinery" murmur at Lt base
PDA treatment options
Indomethocin may close it,
surgical ligation within 12 months
Coarctation of Aorta - define
narrowing of the throacic portion of descending aorta where the ductus arteriosus inserts
Coarctation of Aorta - findings
most are asymptomatic in infancy
may present with upper limb HTN and lower limb hypotension, absent or weak femoral pulses
What should be considered in coarctation of aorta in females?
Turner's syndrome
Cyanotic heart lesions - define
neonatal cyanosis without respiratory distress caused by congenital anitomical abnormalities
Tetralogy of Fallot ToF - 4 classic findings
Tetralogy: Pulmonary stenosis, Rt ventricular hypertrophy, Overriding aorta, and VSD (PROV it!)
ToF exam findings & Tx
cyanosis, grade 2-4 harsh systolic ejection murmur at lt base radiating to back. Boot-shaped heart on CXR.
Treatment: surgical repair
transposition of great arteries
severe cyanosis at birth due to abnormality in spiral division of truncus arteriosus (switched aorta and pulm. artery). Needs surgery in 4-7 days.
Truncus arteriosus
Single great artery for systemic, pulmonic, and coronary circulations. no cyanosis usually, but presents with early CHF, always with VSD, and grade 2-4 SEM at LLSB
Hypoplastic Left Heart Syndrome
Survival depends on PDA - when it closes, rapid deterioration. Includes mitral +/- aortic atresia (closure),
Tx PGE infusion + must repair within 5-7 days
Kawasaki disease - define
Autoimmune disease affecting med-sized arteries. Multiple cardiac effects include pericarditis, myocarditis, coronary arteritis, and coronary artery aneurisms.
Diagnostic criteria for Kawasaki disease (5)
Fever > 5 days, Conjunctivitis, Lip erythema/fissures, Cervical unilateral lymphadenopathy, Rash on trunk and extremities
What is the leading cause of acquired heart disease in children?
Kawasaki disease
Phases of Kawasaki disease (3)
Acute (1-2 weeks): fever, diagnostic criteria, myo/pericarditis
Sub-acute (1-4 weeks): fever resolves, desquamation of fingers/toes, thrombocytosis, and coronary aneurism
Convalescent (1-2 mo): normalization of symptoms
Kawasaki treatment
IV immune globulin, aspirin for heart, steroids
Acute Rheumatic Fever - define
sequelae of group A Strep infection caused by crossreaction of anti-strep antibodies with cardiac antigens. Results in myocardial and valvular inflammation.
peak ages for rheumatic fever
5-15 yo
Acute Rheumatic Fever - presentation (3)
febrile illness with carditis (new murmur)
neurologic movement disorder (chorea)
Acute Rheumatic Fever - diagnosis
Modified Jones Criteria
Major manifestations: carditis, Syndenham chorea, polyarthritis, erythema marginatum, subcutaneous nodules
Acute Rheumatic Fever - treatment
PCN oral x 10 days
aspirin (high dose for 2 days), steroid (prednisone)
Whats the most common valvular sequelae of rheumatic fever?
Mitral insufficiency
Endocarditis - define
bacterial infection on endocardium
What procedures are associated with endocarditis? (3)
dental procedures, respiratory tract procedures, surgery on infected skin/tissues
What cardiac conditions are associated with endocarditis? (3)
Prosthetic heart valves, unrepaired CHD (or repaired within 6 months), prior Hx of endocarditis
Common signs/symptoms of endocarditis
Fever, weight loss, joint pain, new/changing heart murmur, splenomegaly, petechiae, clubbing, CHF signs
Infective endocarditis - organisms
Strep viridans (40-50%)
Staph aureus (30%)
Fungi (10%)
Infective endocarditis - Tx
IV Nafcillin + gentamycin
Seizure disorder - define
paroxysmal electrical discharge of neurons in the brain causing alterations of function or behavior
Epilepsy - define
repeated afebrile seizures without cause
highest incidence 4-16 years, majority resolve in childhood
Status epilepticus
clinical or electrical seizure more than 30 minutes
What are absence seizures?
also called petit mal seizures: episodic loss of clinical consciousness for 15-30 seconds
What are simple partial/focal seizures?
also called aura: affects small portion of the brain and is NOT associated with loss of consciousness
What is a complex partial seizure?
epileptic seizure with bilateral cerebral hemisphere involvement - associated with loss of clinical consciousness and motility
What is a tonic-clonic seizure?
also called grand mal seizure: involvement of entire brain with loss of consciousness and convulsions
Treatment for epilepsy
What is the most common type of seizure in childhood?
Febrile seizure - temp > 38.8
mostly viral cause
6 months - 5 years (peak 18 months)
Simple febrile seizures
> 90% of seizures are generalized (tonic-clonic) of less than 15 minutes duration
Complex febrile seizures
less common: focal or >15 minutes or recurrent
What is aseptic meningitis?
Viral cause of meningeal inflammation
Most often enteroviruses, almost always self-resolve
Halmark signs of meningitis
Fever, headache, nuchal rigidity, positive Kernig's and Brudzinski's signs, bulging fontanelle in infants
CSF differentiation of viral vs bacterial meningitis
Viral: WBC count in 100's, mostly lymphs, normal or slight increase protein, normal glucose
Bacterial: WBC in 1000's, mostly PMNs, high protein, low glucose
Bacterial meningitis - treatment
parenteral (IV,IM) antibiotics
Ampicillin + Cefotaxime (+Gent), +/-Ceftriaxone
Hydrocephalus - define
increased CSF volume associated with ventriculomegaly
causes: hemorrhage, infection, tumor, malformation
Communicating vs. non-communicating hydrocephalus
Communicating - CSF circulates through ventricular system and subarachnoid space
Non-communicating - CSF blocked from subarachnoid
Signs/symptoms of hydrocephalus
Macrocephaly (> 2 SD above mean), irritability, N/V, impaired occular movement, hyperreflexia, papilledema
Hydrocephalus - treatment
ventriculoperitoneal shunt
Cerebral palsy - define
chronic, static impairment of muscle tone, strength, coordination, or movements.
umbrella term further defined by symptoms
Spastic cerebral palsy (5 types)
most common cerebral palsy: Tight and stiff
monoplegia, hemiplegia (unilateral arm>leg), diplegia (leg>arm), paraplegia (both legs), quadriplegia (4 limbs)
Ataxic cerebral palsy
low muscle tone and poor coordination, usually arms affected more than legs
What is second impact syndrome
patients recovering from concussion are at greater risk of severe complications from a second head injury due to loss of cerebrovascular autoregulation - rapid onset of brain edema leading to high mortality
Treatment of concussion
complete rest until resolution of symptoms (usually 7-10 days), then progressive return to activity over 5 days