UNITEK PEDS STUDY GUIDE QUIZ 2 2.0

What is atrial septal defect (ASD)?

An abnormal opening between the atria allows oxygenated blood to flow from left to right atrium, increasing pulmonary blood flow.

What are the common signs and symptoms of ASD?

Most children are asymptomatic; a heart murmur may be present.

How is ASD diagnosed?

By heart murmur on exam and confirmed with echocardiography.

How is ASD treated?

Small defects may close spontaneously; larger defects require surgical patch repair and low-dose aspirin for 6 months.

What is a serious complication of untreated ASD?

Stroke.

What is ventricular septal defect (VSD)?

An abnormal opening between the ventricles allows left-to-right blood flow, increasing pulmonary circulation.

What are the common signs and symptoms of VSD?

Loud, harsh murmur with systolic thrill; small defects may be asymptomatic.

How is VSD diagnosed?

By characteristic murmur and echocardiography.

How is VSD treated?

Small defects may close spontaneously; larger defects require surgical closure with sutures or patch.

What is patent ductus arteriosus (PDA)?

Failure of the ductus arteriosus to close after birth which allows blood from the aorta to flow into the pulmonary artery, increasing pulmonary circulation.

What are the common signs and symptoms of PDA?

Bounding pulses, widened pulse pressure, dyspnea, fatigue, and a continuous "machine-like" heart murmur.

How is PDA diagnosed?

Echocardiography to visualize blood flow across the ductus.

How is PDA treated medically?

Give them Indomethacin

What procedures treat PDA?

Coil occlusion via catheterization or surgical ligation.

What is aortic stenosis?

Narrowing of the aortic valve obstructs left ventricular outflow, causing hypertrophy and increased workload.

What are the signs and symptoms of aortic stenosis in infants and children?

Infants: poor feeding, heart failure, poor weight gain; Children: fatigue, dyspnea, chest pain, dizziness, or syncope.

How is aortic stenosis diagnosed?

Echocardiography showing pressure gradient across the aortic valve.

How is aortic stenosis treated?

Observation if mild; balloon valvuloplasty or surgical repair if severe or symptomatic.

What teaching is important for children with aortic stenosis?

Avoid strenuous or competitive sports.

What is tetralogy of Fallot?

Combination of VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy causes decreased pulmonary blood flow and cyanosis.

What are the signs and symptoms of tetralogy of Fallot?

Cyanosis, dyspnea on exertion, feeding difficulties, failure to thrive, frequent respiratory infections, and tet spells.

What are tet spells and how are they managed?

Paroxysmal hypercyanotic episodes treated with knee-chest positioning.

How is tetralogy of Fallot diagnosed?

Echocardiography and chest X-ray showing boot-shaped heart.

How is tetralogy of Fallot treated?

Temporary Blalock-Taussig shunt in infancy followed by complete surgical repair between 4 months-2 years.

What is the congestive heart failure (CHF) in children?

The heart cannot pump enough blood to meet metabolic demands, causing pulmonary/systemic congestion.

What are common signs and symptoms of CHF in infants?

Tachycardia at rest, tachypnea, dyspnea, poor feeding, fatigue, diaphoresis, cyanosis, pallor, edema, weak cry, and frequent respiratory infections.

Why do infants with CHF have feeding difficulties?

Feeding increases energy demand causing fatigue and dyspnea.

What medications are first-line for pediatric CHF?

ACE inhibitors (captopril, enalapril, lisinopril) to reduce afterload, digoxin, and diuretics (furosemide, spironolactone) to reduce fluid overload.

What type of diuretic is spironolactone?

Potassium-sparing diuretic

What is digitalis toxicity?

A potentially dangerous condition caused by excessive levels of digoxin in the bloodstream, leading to impaired cardiac conduction and arrhythmias

What are the signs and symptoms of digitalis toxicity?

Nausea, vomiting, anorexia, bradycardia, arrhythmias, fatigue, weakness, dizziness, confusion, and visual disturbances (blurred or yellow vision)

How is digitalis toxicity treated?

Stopping the drug, and beginning treatment of symptoms as needed.

What monitoring is important with ACE inhibitors?

Blood pressure, renal function, and serum potassium.

What complications can occur with diuretics?

Hypokalemia; monitor and encourage potassium-rich foods.

What is of rheumatic fever?

Autoimmune response 1-6 weeks after untreated group A strep infection causing connective tissue and heart valve damage.

What are major signs and symptoms of rheumatic fever?

Carditis (heart), Migratory polyarthritis (joints), erythema marginatum, Sydenham's chorea (CNS), and subcutaneous nodules (skin; rash on the trunk).

What is rheumatic carditis?

Inflammation of heart layers and valves, most commonly the mitral valve, which can cause permanent damage.

How is rheumatic fever diagnosed?

Modified Jones Criteria plus evidence of recent strep infection (elevated ASO titer).

How is strep infection treated?

Penicillin or amoxicillin for 10 days; erythromycin if allergic.

Why is long-term prophylactic antibiotics needed?

To prevent recurrence of rheumatic fever.

What is iron deficiency anemia?

Insufficient iron decreases hemoglobin production, reducing oxygen-carrying capacity of RBCs.

Why are infants and adolescents at high risk of iron deficiency anemia?

Rapid growth increases iron requirements which are not always met by diet.

What are common signs and symptoms of iron deficiency anemia?

Pallor, fatigue, irritability, poor appetite, decreased activity.

How is iron deficiency anemia treated?

Oral ferrous sulfate 2-3 times daily between meals; vitamin C enhances absorption.

How should ferrous sulfate be taken?

in between meals. Given with a straw if it is an oral liquid and Z track method if given IM. Give with vitamin C.

What should avoided when taking ferrous sulfate

Milk and Caffeine

What are precautions for iron therapy?

Avoid excess cow's milk, keep iron supplements out of reach of children, expect dark stools.

What substances decrease iron absorption?

Phytates (whole grains, legumes), polyphenols/tannins (tea, coffee, wine, cocoa), calcium (dairy), and oxalic acid (spinach, nuts)

What is sickle cell anemia?

Inherited hemoglobin S disorder causing sickle-shaped RBCs, hemolysis, and vaso-occlusion.

What are common baseline signs of sickle cell anemia?

Chronic anemia, pallor, fatigue, poor appetite, delayed growth.

What is a sickle cell crisis?

Acute vaso-occlusion causing severe pain, swelling (dactylitis), abdominal pain, and fever.

What triggers sickle cell crises?

Dehydration, infection, hypoxia, cold, stress, acidosis.

How is a sickle cell crisis managed?

Pain control, hydration, oxygen, infection prevention; avoid meperidine.

What medication reduces crisis frequency?

Hydroxyurea which increases fetal hemoglobin.

What is hemophilia A?

Congenital factor VIII deficiency causing impaired clotting and prolonged bleeding.

What are hallmark symptoms of hemophilia A?

Hemarthrosis (bleeding into joints), prolonged bleeding after injury, bruising, hematomas.

How is hemophilia A treated?

Factor VIII replacement; desmopressin (DDAVP) for mild cases; avoid NSAIDs/aspirin.

What is leukemia?

Malignant proliferation of immature WBCs in bone marrow causing marrow failure.

What are common signs and symptoms of leukemia?

Fever, pallor, fatigue, bruising, petechiae, anorexia, weight loss.

How is leukemia diagnosed?

Blood tests showing blasts and bone marrow aspiration; lumbar puncture for CNS involvement.

How is leukemia treated?

Combination chemotherapy, possible bone marrow/stem cell transplant in refractory cases.

What should you do if a child is having a blood transfusion for leukemia and they mention itching or chills

Discontinue the transfusion

What is the purpose of a bone marrow aspiration?

To evaluate blood cell production and identify abnormal cells

Why is bone marrow aspiration used in leukemia?

To confirm diagnosis and assess extent of disease

Where is bone marrow aspiration typically done?

iliac crest

What is a concussion?

A brain injury caused by a blow to the head that results in altered mental functioning.

What symptoms suggest a concussion?

Headache, confusion, dizziness, nausea, vomiting, or loss of consciousness.

What is the first thing you check for a concussion?

Level of consciousness and make sure they do not sleep.

What is a "stinger" or "burner"?

A neck or shoulder nerve injury causing a sudden burning or electric shock sensation down the arm.

What causes a stinger injury?

Trauma to the brachial plexus, commonly seen in football or contact sports.

Why are X-rays important for ankle injuries in adolescents?

To assess for growth plate (epiphyseal) injury

What causes muscle cramps during sports?

Muscle fatigue, dehydration, or electrolyte imbalance

How are muscle cramps prevented?

Adequate hydration, warm-up, and stretching

What are shin splints?

Lower leg pain caused by repetitive running on hard surfaces

How are shin splints managed?

Rest, proper footwear, and reducing repetitive impact

What is the initial treatment for most sports injuries?

Rest, ice, compression, elevation (RICE), and activity restriction.

What neurovascular checks are required for a fractured femur?

Color, temperature, pulses, capillary refill, movement, sensation

What is compartment syndrome?

Increased pressure in a muscle compartment causing ischemia.

What are signs of compartment syndrome?

Severe pain unrelieved by meds, pain with passive movement, pallor, paresthesia, paralysis, weak pulses.

How is compartment syndrome treated?

Immediate fasciotomy to relieve pressure and restore circulation

What is a fat embolism?

Fat from bone marrow enters circulation, causing respiratory distress, hypoxia, tachypnea, petechiae.

How is fat embolism treated?

Supportive care including oxygen and respiratory support

What teaching is important for cast care?

Keep dry, elevate extremity, do not insert objects, report pain, numbness, swelling, or discoloration.

What are the classic signs of a cast that is too tight?

Increasing pain, numbness, tingling, swelling, cyanosis, decreased movement

What is osteomyelitis?

Bacterial infection of bone causing inflammation, pressure, and possible necrosis.

What are the most common causes for osteomyelitis

Complication of pin care and MRSA

What are common signs of osteomyelitis?

Fever, localized bone pain, swelling, redness, warmth, refusal to bear weight. WBC and ESR go up.

How is osteomyelitis treated?

IV antibiotics for 4-6 weeks; surgical drainage if abscess/necrosis present.

What is ESR?

Erythrocyte Sedimentation Rate, used to determine the progress of an inflammatory disease

What does a normal or decreasing ESR indicate?

Healing and effective treatment

What is scoliosis?

Abnormal lateral spinal curvature often during adolescence.

How is scoliosis screened?

Have child bend forward with arms loose to see if back is parallel to the ground

What are common signs of scoliosis?

Uneven shoulders/hips, rib hump, asymmetry when bending forward.

How is mild scoliosis managed?

Observation, posture exercises.

When is bracing used to treat scoliosis?

If curves are 20-40° to prevent progression.

When is surgery indicated?

If curves are greater than 45° or there is progressive deformity.

What is JIA (juvenile idiopathic arthritis)?

Chronic autoimmune inflammation of synovial joints causing pain, swelling, stiffness, and potential joint damage.

What are common symptoms of JIA?

Joint swelling, stiffness worse in morning, pain, warmth, limited range of motion, fatigue, fever, rash.

What eye complication may occur as a result of JIA?

Uveitis.

What is uveitis?

A serious form of eye inflammation that affects the middle layer of tissue (uvea) in the eye, often causing sudden redness, pain, blurred vision, and light sensitivity.