Step 2 Peds

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Anonymous
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28677
Filename:
Step 2 Peds
Updated:
2010-08-01 20:01:31
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USMLE Step
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Step 2 Peds
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  1. What peds fxrs can indicate abuse
    • Spiral Fxrs
    • bucket fxrs
    • post. rib fxrs
  2. Drugs that cause congenital heart defects
    • phenytoin
    • alcohol
    • lithium
    • thalidomide
  3. Non cyanotic heart dz
    • ASD
    • VSD
    • PDA
  4. Cyanotic heart dz
    • Rt-->Lft shunt
    • "12345"

    • Truncus arterioss
    • Transposition of great vessels
    • Tricuspid atresia
    • Tetralogy of fallot
    • Total Anomalous Pulmonay Venus Retun
  5. MC congenital heart defect
    VSD
  6. VSD is assoc with what syndrome
    • Apert's Syndrome
    • cranial deformity
    • fusion of fingers/toes

    • Down's
    • Fetal Alcohol Syndrome
    • TORCHES
    • Cri du Chat
    • Trisomies 13, 18
  7. VSD Murmur
    Dx with...
    CXR findings
    • harsh holosystolic murmer
    • L sternal border

    Dx with Echo

    • CXR: poss LVH w/ small defects
    • LVH+RVH w/ larger defects
    • ^pulm vascular markings
  8. VSD Tx
    small defects close spontaneously

    • Surgery if:
    • pts fail medical management
    • pts <1yo + pulm HTN
    • older kids w/ large VSD that hasnt shrunk
  9. ASD assoc'd syndromes
    • Holt-Oram Syndrome
    • absent radii
    • ASD
    • 1st deg heart block

    • FAS
    • Downs
  10. Ostium Primum and secundum
    which is most common
    Age of "presentation"
    • 1: si/sx in early childhood
    • 2: si/sx in late chldhood, or early adulthood

    2 is most common
  11. ASD murmur
    • RT ventricular heave
    • Systolic Ejection murmur
    • Upper Left Sternal border
    • **Wide and Fixed, Split S2**

    may also have mid-diastolic rumble at left lower sternal border
  12. ASD Dx

    EKG findings
    CXR findings
    • Echo: shows blood flow btwn atria
    • EKG: R axis deviation and RVH, PR prolongation is common
    • CXR: cardiomegaly ^ pulm vascular markings
  13. ASD Tx
    most are small and resolve spontaneously

    • Surgery:
    • infants w/ CHF
    • >2:1 pulmonary to systemic blood flow
  14. Eisenmenger's syndrome
    • L-to-R shunt --> Pulm HTN
    • Pulm HTN--> shunt reversal
  15. PDA risk factors
    Si/Sx
    • 1st trimester Rubella infxn
    • prematurity
    • female

    • Usually no symptoms
    • Large defects:
    • FTT
    • recurrent lower RI's
    • Lower extremity clubbing
    • CHF
  16. PDA PE findings
    • Wide Pulse Pressure
    • continuous "machinary murmur"
    • 2nd L IC space at sternal border
    • loud S2
    • bounding Periph pulses
  17. PDA Dx
    EKG/CXR findings
    Tx
    TOC: Color flow doppler

    • EKG: poss LVH
    • CXR: poss cardiomegaly w/ large lesions

    • Tx: Indomethacin
    • CI: cyanotic heard dz
  18. Ebsteins anomaly
    • Tricuspid Valve displacement into Right Vent
    • **associated with mom taking LITHIUM**
  19. When does PDA need Sx
    child >6-8 yo and indomethacin fails
  20. Conditions assoc w/ Coarctation of Aorta
    • Bicuspid aortic valve (2/3 of patients)
    • Turner's
    • Berry Aneurysms
    • males
  21. Si/Sx of Coarctation
    • SPB upper extremities > lower
    • Different PB in L and R arms
    • **Differential Cyanosis
    • Weak femoral pulses
    • Childhood HTN
    • LE claudication
    • syncope
    • epistaxis
    • HA
  22. Coarctation murmur
    • short systolic murmur
    • in left axilla
    • forceful apical impulse
  23. Coarctation of Aorta
    Dx
    CXR:
    ECG:
    • Dx with Echo and color flow doppler
    • CXR: cardiomegaly and pulm congestion
    • ECG: "3" sign d/t pre/post ductal dilation, rib notching
  24. Coarctation Tx
    • Severe coarctation needs PDA kept open with...
    • PGE1
    • Surgery or alloon angioplasty
    • Monitor for:
    • restenosis
    • aneurysm
    • aortic dissection
  25. MC cyanotic congenital heart lesion in the newborn
    Transposition GV (per 1st Aid)
  26. Transposition of GV PE
    • Tachypnea
    • progressive hypoxemia
    • extreme cyanosis
    • Poss signs of CHF
    • Single loud S2
  27. Transposition GV
    Dx:
    CXR findings:
    • Dx: Echo
    • CXR: narrow base heart, no main pulm artery segment
    • "egg-shaped heart"
    • ^ pulm vascular markings
  28. Trans. GV Tx
    • IV PGE1 to keep PDA open
    • Balloon atrial septostomy to creat/enlarge ASD if PGE1 fails
  29. Tetralogy of Fallot
    consists of:
    • "PROV"
    • Pulmonary stenosis
    • RVH (R vent. outflow obstruction)
    • Overriding arota
    • VSE

    **MC cyanotic congenital heard dz in children**
  30. Tetralogy of Fallot
    Si/Sx
    • no cyanosis at birth, develops over 1st 2 yrs
    • degree of cyanosis reflects extent of pulm stenosis

    • Infants often no symptoms 'til 4-6 mos
    • 4-6 mos when CHF poss and manifests as sweating w/ fedding or tachypnea
    • Hypoxemia may -->FTT
    • "Tet spells"
  31. Tet. of Fallot
    murmur:
    Dx:
    CXR:
    EKG:
    • Murmur: syst. ejection @ L upper sternal border
    • R vent heave, single S2

    • CXR: boot shaped heart, v pulm vasc markings
    • EKG: R-axis dev and RVH
  32. Tet of Fallot Tx
    • if severe pulm stenosis: immediate PGE1
    • tet spells:
    • Morphine
    • O2
    • Phenylephrine
    • propanolol
    • squatting
    • "tx tet spills w/ MOPPS"
  33. Down's Syndrome
    PE:
    Associations:
    Malignancy association:
    MR, flat facial profile, Prominent epicanthal folds, simian crease

    • Assoc: ^maternal age, duodenal atresia, Hirschsprung's,
    • endocardial cushion (ASD, VSD, Mitral/Triscuspid valve abnormalities)

    Malignancy: ALL

    Other: hypothyroidism, early Alzheimer's
  34. Edward's Syndrome
    • Trisomy 18
    • Rocker-bottom ears

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