Pediatric Cardiology CHD Overview

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Questions and Answers

Acyanotic Congenital Heart Diseases (ACHD) constitutes ______% of all CHD

What is the most common cyanotic congenital heart disease with decreased pulmonary blood flow?

Fallot Tetralogy

What is the definition of heart failure?

The heart is unable to pump enough blood to meet the body's needs.

What are the two major criteria of rheumatic fever?

Arthritis and Carditis Signup and view all the answers

What is the definition of infective endocarditis?

Infection of the valvular & mural endocardium. Signup and view all the answers

What are the two factors that contribute to the pathogenesis of infective endocarditis?

Presence of cardiac disease and Bacteremia. Signup and view all the answers

What is the definition of anemia?

Reduction of hemoglobin and/or RBCs count. Signup and view all the answers

Iron deficiency anemia is the most common cause of anemia in pediatrics.

True Signup and view all the answers

What is the definition of megaloblastic anemia?

Anemia with megaloblasts in BM and macrocytes in peripheral blood. Signup and view all the answers

What are the two main causes of megaloblastic anemia?

Vitamin B12 (cobalamin) deficiency and Folic acid deficiency. Signup and view all the answers

What is the definition of thalassemia?

Autosomal recessive disorders due to defective globin chain production. Signup and view all the answers

The most common chronic hemolytic anemia in Egypt & Mediterranean areas is what?

B thalassemia Major (Cooley's anemia) Signup and view all the answers

What is the etiology of sickle cell disease?

Autosomal recessive disorder. Signup and view all the answers

What are the five types of crises associated with sickle cell disease?

Aplastic, Hemolytic, Megaloblastic, Hyperhemolytic and Vaso-occlusive crisis (painful crisis) Signup and view all the answers

What is the definition of hemophilia A?

Sex-linked recessive coagulation defect due to deficiency of factor VIII Signup and view all the answers

What is the most common indication for adenoitonsilectomy?

Adenotonsillar hypertrophy associated with obstructive sleep apnea Signup and view all the answers

What are the two most common causes of acute otitis media?

Viral and Bacterial Signup and view all the answers

The maxillary and ethmoid sinuses are the most commonly involved in acute sinusitis.

True Signup and view all the answers

What are the most common risk factors for acute sinusitis?

Upper respiratory tract infections and immunodeficiency Signup and view all the answers

Which viral types are most common in acute laryngotracheobronchitis?

Viral types 1, 3 Signup and view all the answers

What condition is caused by an infection of the epiglottis typically by Hemophilus influenza type B?

Acute Epiglottitis (Supraglottitis) Signup and view all the answers

"Pneumonia is an infection of the [blank] respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces"

lower Signup and view all the answers

What respiratory virus causes bronchiolitis in approximately 50% of cases?

Respiratory syncytial virus (RSV) Signup and view all the answers

What common bacterium causes tuberculosis?

Mycobacterium TB bacilli Signup and view all the answers

What is the incubation period for scarlet fever?

3 days Signup and view all the answers

What is the most infectious stage of pertussis?

Catarrhal stage Signup and view all the answers

What is the incubation period for measles?

1-2 weeks Signup and view all the answers

What is the incubation period for rubella?

2-3 weeks Signup and view all the answers

What is the incubation period for chickenpox?

Chickenpox, a highly contagious viral infection caused by the varicella-zoster virus, is characterized by a distinctive itchy rash and fever. The incubation period, the time between infection and symptom onset, is typically 2-3 weeks. Signup and view all the answers

What are the common clinical features of mumps?

Mild fever, malaise & myalgia. Signup and view all the answers

What is the definition of acute renal failure?

Rapid deterioration in renal function characterized by ↑ waste products and oliguria (reversible). Signup and view all the answers

What are the major types of acute renal failure?

Pre-renal, Renal and Post-renal. Signup and view all the answers

What is the normal glomerular filtration rate (GFR)?

90-130ml/minute Signup and view all the answers

The clinical picture of [blank] is basically in pre renal failure

acute renal failure Signup and view all the answers

What is the definition of chronic kidney disease?

A slowly progressive irreversible deterioration of kidney function for >3 months with development of the clinical syndrome of uremia. Signup and view all the answers

The normal glomerular filtration rate (GFR) in chronic renal failure is?

90-130ml/minute Signup and view all the answers

What is the definition of glomerulonephritis?

Group of diseases with acute glomerular injury cases by immunologic mechanism. Signup and view all the answers

What is the most common type of glomerulonephritis in children?

Acute Poststreptococcal Glomerulonephritis (APSGN) Signup and view all the answers

What is a major characteristic under a microscope in APSGN?

Dysmorphic RBCs/RBCs casts Signup and view all the answers

What is the definition of nephrotic syndrome?

Clinico-laboratory condition characterized by: Hypoalbuminemia, generalized edema, and hyperlipidemia. Signup and view all the answers

What is the most common cause of nephrotic syndrome?

Idiopathic or autoimmune. Signup and view all the answers

What are the major complications of nephrotic syndrome?

Hypovolemia, acute renal failure and intravascular thrombosis Signup and view all the answers

What is the most common organism in UTIs?

Escherichia coli Signup and view all the answers

What is the definition of meningitis?

Inflammation of the membranes covering the brain and spinal cord. Signup and view all the answers

What are the most common bacteria in neonatal meningitis?

E.coli, Listeria monocytogenes and Streptococci. Signup and view all the answers

What are the most common causes of seizures?

All of the above Signup and view all the answers

What is the definition of febrile convulsions?

Seizures in children due to: Rapid rise of body temperature. Due to extra cranial causes (mostly viral). Signup and view all the answers

What is the definition of epilepsy?

It is considered to be present when 2 or more unprovoked seizures occur in a time frame of longer than 24 hr or At least 1 unprovoked epileptic seizure with enough EEG and clinical information to demonstrate recurrences Signup and view all the answers

What are the two main types of seizures?

Focal (partial) and Generalized. Signup and view all the answers

What is the definition of cerebral palsy?

A group of permanent disorders of movement and posture causing activity limitation Signup and view all the answers

What are the three major categories of cerebral palsy?

Pre-natal, Natal, Post-natal Signup and view all the answers

Study Notes

Pediatric Cardiology - Congenital Heart Disease (CHD)

8 per 1000 live-born infants have significant cardiac malformation
Risk factors include genetic predisposition, exposures during pregnancy (drugs or disease), and chromosomal abnormalities.
Acyanotic CHD accounts for 80% of all CHDs.
Common lesions in ACHD with left-to-right shunt include ventricular septal defect (VSD), patent ductus arteriosus (PDA), and atrial septal defect (ASD).
Clinical manifestations of high pulmonary blood flow can include poor feeding, recurrent chest infections, chest wheezes, recurrent heart failure, and growth failure.
Heart failure, while uncommon in full-term neonates, may occur in infancy as pulmonary vascular pressure declines.
Obstructive lesions, such as aortic coarctation, aortic stenosis, and pulmonary stenosis, are another category of ACHD.
Eisenmenger syndrome is a complication of prolonged high pulmonary blood flow, leading to pulmonary hypertension, reversal of the shunt, and central cyanosis.
Risk is higher with large unrepaired defects.

Pediatric Cardiology - Ventricular Septal Defect (VSD)

Definition: Defect anywhere in the interventricular septum
Hemodynamics: Blood is shunted from the left ventricle (higher pressure) to the right ventricle (lower pressure), increasing pulmonary blood flow.
Clinical features: Pulmonary congestive symptoms, volume overload of the right ventricle, left atrium, and left ventricle.

Pediatric Cardiology - Atrial Septal Defect (ASD)

Definition: Defect in the interatrial septum
Hemodynamics: Increased pulmonary blood flow.
Clinical features: Pulmonary congestive symptoms, volume overload over the right ventricle, left atrium, and left ventricle

Pediatric Cardiology - Patent Ductus Arteriosus (PDA)

Definition: Persistent fetal duct connecting the aorta and the pulmonary artery.
Association: Associated with congenital rubella syndrome and premature infants.
Medical closure: In preterm infants by IV indomethacin in the first week of life.

Pediatric Cardiology - Atrioventricular Septal Defect (AVSD)

Definition: Defect in the atrioventricular septum, often complete, sometimes involving a common atrioventricular valve.
Association: Commonly associated with Down syndrome.
General manifestations: Often asymptomatic; if large, dyspnea during suckling, recurrent chest infections reflecting pulmonary congestion, tachycardia, and enlarged tender liver (heart failure).
Complications: Infective endocarditis, higher risk of Eisenmenger syndrome, heart failure.
Treatment: Medical control of heart failure and antibiotics for chest infections to avoid endocarditis; surgical intervention for symptomatic large defects with uncontrollable heart failure or growth failure.

Pediatric Cardiology - Fallot Tetralogy

Definition: Commonest cyanotic congenital heart disease with decreased pulmonary blood flow; characterized by four defects: pulmonary stenosis, ventricular septal defect (VSD), right ventricular hypertrophy, and overriding aorta
Hemodynamics: Decreased pulmonary blood flow
Clinical picture: Central cyanosis noticeable immediately or later in the first year of life. Cyanotic clubbing of fingers/toes, growth retardation, squatting position for relief of dyspnea, paroxysmal hypercyanotic spells (hypoxic crises).
Investigations: Chest X-ray (boot-shaped heart), echocardiography (diagnostic), ECG (shows RVH), CBC (polycythemia).
Complications: Polycythemia due to hyoxemia, pulmonary tuberculosis due to pulmonary oligaemia, endocarditis
Treatment: Medical (treat the hypoxic spells), Surgical intervention, indicated as soon as the spells begin

Pediatric Cardiology - Heart Failure

Definition: Inability of the heart to pump enough blood to meet body needs
Causes: Congenital heart disease, rheumatic heart disease, myocarditis, infective endocarditis, severe anemia, nutritional deficiencies (e.g., Kwashiorker), dysrhythmias, dilated cardiomyopathy, cor pulmonale.
Clinical features (infants): Poor feeding, dyspnea while sucking, sweating profusely, poor weight gain.
Clinical features (older child): Dyspnea on exertion, effort intolerance, ankle edema.
Signs : Tachycardia, gallop rhythm, and weak pulse, cold and sweaty skin

Pediatric Hematological Diseases - Anemia

Definition: Reduction of hemoglobin and/or RBC count below the average value for age and sex, interfering with oxygen-carrying capacity of the blood.
General features: Fatigue, headaches;, faintness, palpitations, breathlessness, angina, intermittent claudication, pallor, tachycardia, hemic murmurs
Classification: Morphologic (microcytic, normocytic, macrocytic) and etiologic (decreased production, increased destruction, blood loss).
Causes (Examples): Decreased production: pure red cell anemia, aplastic anemia. Increased destruction: hereditary spherocytosis, hereditary elliptocytosis. Specific factor deficiency: iron, copper, vitamins B6, B12, folate, and protein deficiency.

Pediatric Hematological Diseases - Iron Deficiency Anemia (IDA)

Incidence: The most common cause of anemia in pediatrics.
Causes: Decreased iron intake (e.g., delayed weaning in infants), decreased iron absorption (e.g., excess tea, phytate, certain medications), increased iron loss (e.g., occult blood loss, overt blood loss).
Clinical picture: Mild anemia may be asymptomatic. Systemic manifestations may include decreased alertness, learning and concentration span, atrophic glossitis, angular stomatitis, brittle nails.
Investigations: CBC (anemia, hypochromia, microcytosis), stool analysis for parasites and occult blood, work-up for malabsorption, work-up for hemorrhagic diseases

Pediatric Hematological Diseases - Megaloblastic Anemia

Definition: Anemia with megaloblasts in bone marrow and macrocytes in peripheral blood, caused by vitamin B12 or folic acid deficiency.
Sources: Vitamin B12: Animal origin. Folic acid: animal and plant food
Causes (Examples): Decreased intake, impaired absorption, increased requirements (pregnancy), increased loss
Clinical Features (Examples): Anemia (anorexia, pallor, tiredness), jaundice, thrombocytopenia, leucopenia, mild hepatosplenomegaly, gastrointestinal manifestations
Diagnosis: Complete blood count (CBC), serum B12, serum folate
Treatment (Examples): B12 deficiency: Hydroxocobalamin. Folic acid deficiency: Folic acid supplementation
Prevention: Dietary intake, supplements

Pediatric Hematological Diseases - Thalassemia

Definition: Autosomal recessive disorders due to defective globin chain production
Classification: Ą thalassemia syndromes (various degrees of gene deletion leading to different severity), and B thalassemia syndromes (various degrees of gene mutation leading to different severity)
Clinical Features: Progressive anemia, jaundice, thalassemic facies, organomegaly

Pediatric Hematological Diseases - Sickle Cell Disease

Etiology: Autosomal recessive disorder caused by a single amino acid substitution in the beta chains of hemoglobin. Red blood cells with sickle shape are destroyed prematurely, leading to anemia and various complications
Clinical Presentations: Anemia, chronic hemolysis, kidney problems, aplastic crises, hemolytic crises, megaloblastic crises, vaso-occlusive crises (painful crises).
Investigations: Blood film (sickle cells), hemoglobin electrophoresis (showing HbS and possibly HbF)
Treatment: Supportive, including pain control, hydration, and possibly blood transfusions. Prophylactic measures, possibly chronic transfusions.

Infections Diseases - Acute Pharyngitis

Definition: viral or bacterial infection of the throat involving tonsils and/or pharynx.
Causes: Mostly viral, Group A beta hemolytic streptococci
Complaints: Fever, anorexia, malaise, sore throat, dysphagia, red and congested throat, inflamed tonsils, enlarged tender lymph nodes, conjunctivitis , minute vesicles and ulcers
Treatment: symptomatic therapy for mild cases and specific antibiotics (eg., penicillin, Zithromax) for bacterial infections, for 10 days

Infections Diseases - Acute Otitis Media (AOM)

Causes: Typically viral or bacterial in nature. Bacterial types include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis
Clinical Picture: Fever, earache (esp. in irritable infants)
Investigations: Otoscopic examination.
Treatment: Pain control (ibuprofen or acetaminophen), antibiotic treatment (use amoxicillin-clavulanate, alternative antibiotics ceftriaxone, cefdinir, or cefpodoxime). Surgical drainage(if needed eg. perforation)

Infections Diseases - Acute Sinusitis

Causes: Usually related to upper respiratory tract viral infections
Signs: - fever, headache, purulent or mucopurulent nasal discharge/postnasal discharge/cough
Investigations: Culture, X-rays
Treatment: symptomatic therapy, antibiotics (e.g high dose amoxicillin or amoxicillin/clavulanate; alternatives include ceftriaxone, cefdinir or cefpodoxime), saline nasal washes/sprays; surgical intervention for chronic cases

Infections Diseases - Acute Infectious Stridor (Croup)

Etiology: Viral, commonly Parainfluenza 1, 3; RSV
Clinical picture: Upper respiratory catarrh (Rhinitis, low-grade fever), Croupy bark, cough , hoarseness of voice, toxic appearance
Management: Home treatment (most cases), hospital indicated for severe cases
Treatment: Oxygen, nebulized epinephrine, corticosteroids (oral or intramuscular)

Infections Diseases - Acute Epiglottitis

Etiology: Hemophilus influenza type B, Streptococcus species, Staphylococcus aureus
Clinical picture: Typically toxic appearance, high fever, severe dysphagia (drooling of saliva), muffled voice, little or no cough, upright posture with hyperextended neck
Management: Medical emergency, securing the airway before any other maneuver, patient admitted to the PICU; antibiotic treatment (eg., ceftriaxone or cefotaxime or meropenem).

Infections Diseases - Pneumonia

Etiology: Bacterial, Viral, Atypical
Clinical Picture: Variable onset, fever, malaise, toxemia. Respiratory distress, tachypnea, nasal flaring, retractions, grunting, cyanosis, cough (dry to productive)
Investigations: Chest x-ray (to aid diagnosis), WBC count, culture, possible serological studies (when viral suspected)
Treatment : supportive care (bed rest, humidified oxygen, etc.), and specific antibiotic treatment for suspected bacterial infections.

Infections Diseases - Scarlet Fever

Etiology: Group A streptococcal infection (GAS) producing erythrogenic toxin
Clinical Picture: Sudden fever, sore throat, red and edematous pharynx, white strawberry tongue (later, red strawberry tongue), diffuse red maculopapular rash. Rash starts around the neck (spreading to trunk), may peel after.
Investigations: Rapid antigen test, culture.
Treatment: Symptomatic care (rest, hydration, pain control), antibiotics (penicillin, amoxicillin).

Infections Diseases - Pertussis (Whooping Cough)

Etiology: Bordetella pertussis
Clinical Picture:
Catarrhal stage (infectious): mild cold-like symptoms
Paroxysmal stage: recurring coughing fits ending in a "whoop" sound, sometimes followed by vomiting.
Convalescent stage: gradual decrease in the frequency and severity of coughing fits.
Investigations: Nasal swab culture
Treatment: Supportive care (rest, fluids, cough suppressants), antibiotics (azithromycin or erythromycin)

Infections Diseases - Measles

Etiology: RNA virus
Clinical Picture: Catarrhal stage (fever, coryza, conjunctivitis, Koplik spots), eruptive stage (maculopapular rash spreading from behind ears to rest of body).
Prevention: MMR vaccine.
Treatment: Support (rest, fluids), vitamin A

Infections Diseases - Rubella

Etiology: RNA virus
Clinical Picture: Mild fever, sore throat. Rash typically maculopapular starting on face and spreading downwards, fading from face as it spreads.

Infections Diseases - Chickenpox

Etiology: Varicella-zoster virus (VZV).
Clinical Picture: Prodromal period may occur 24 - 48 hrs before rash. Rash starts on scalp, face or trunk as macules which evolve to vesicles.
Prevention: Vaccination
Treatment: Supportive care (antipruritics). Antivirals (e.g., acyclovir).

Infections Diseases - Mumps

Etiology: RNA virus
Clinical Picture: Parotid swelling is the common feature, painful, can have swelling in submandibular or sublingual glands as well

Internal Medicine - Nephrology - Acute Renal Failure

Definition: Rapid deterioration of renal function, often characterized by reduced urine output (oliguria or anuria).
Etiology: Pre-renal (decreased blood flow to kidney, eg., dehydration, shock), renal (damage to the kidney tissue, eg., acute tubular necrosis), post-renal (obstruction of urine outflow).
Clinical Picture: Oliguric stage (decreased urine output, fluid retention, edema), polyuric stage (increased urine output), and potential complications from metabolic abnormalities (eg., hyperkalemia).
Investigations: Urine analysis, renal function tests, blood tests(electrolyte balance, metabolic acidosis).
Treatment: Correcting the underlying cause (e.g., fluid resuscitation for hypovolemic shock), supportive care management of complications. Dialysis treatment for severe and complicated cases and persistent symptoms.

Internal Medicine - Nephrology - Chronic Kidney Disease (CKD)

Definition: Progressive irreversible deterioration of kidney function for 3 months or more, with development of uremia symptoms and clinical signs.
Etiology: Diabetes, hypertension, glomerulonephritis, chronic pyelonephritis
Clinical Picture (Examples) :
- Stage 1 and 2: usually asymptomatic
- Stage 3 & 4 : fatigue, weakness, pruritus, metallic taste, shortness of breath
- Stage 5: nausea, vomiting, hiccups, stupor
Investigations: CBC, serum urea, creatinine, creatinine clearance, urine analysis.
Treatment: Management of associated complications (hypertension, anemia, metabolic abnormalities), supportive treatment and possibly dialysis or transplant.

Internal Medicine - Nephrology - Nephrotic Syndrome

Definition: A group of kidney diseases characterized by significant proteinuria (large amounts of protein in urine), hypoalbuminemia, edema, and hyperlipidemia.
Causes: Idiopathic (most common in children), genetic, secondary to other diseases (e.g., infections, systemic illnesses)
Clinical Picture: Severe edema (especially periorbital), hypoalbuminemia, hyperlipidemia, anorexia, abdominal pain.
Investigations (Examples): Urine analysis (proteinuria), blood tests (serum albumin, cholesterol and lipids), urine microscopy, renal biopsy
Treatment: Medications (diuretics, steroids, ACE inhibitors. Avoiding infections is key)

Internal Medicine - Nephrology - Urinary Tract Infections

Causes: Bacterial infections, most commonly by E.coli
Clinical Picture (Newborn): Sepsis
Clinical Picture (Infant): Fever, failure to thrive
Clinical Picture (Older child): Dysuria, frequency, urgency, supra pubic pain
Investigations: Urinalysis; Culture and sensitivity
Treatment: Antibiotics(consider age and immune status), supportive care

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Description

This quiz covers key concepts in Pediatric Cardiology, focusing on Congenital Heart Disease (CHD). Explore risk factors, common lesions, and clinical manifestations associated with both acyanotic and obstructive lesions. Understand the implications of high pulmonary blood flow and conditions like Eisenmenger syndrome.