Case Studies-Kimko

Question 1

What is the healthy weight minimum for a new baby?

Answer 1

2.5kg

Question 2

What are the reasons for poor weightgain in a newborn?

Answer 2

Poor feeding, malabsorption, heart failure

Question 3

How is heart failure indicated with poor feeding?

Answer 3

Sweating during eating because needs more BP and power, implies heart can’t handle exertion

Question 4

What to search for in heart failure in a baby?

Answer 4

Heart sounds, murmur, color and hyperactivity.

Question 5

What is holosystolic murmur pathomnemonic of?

Answer 5

VSD

Question 6

Where is the murmur in VSD?

Answer 6

Lower left sternal border

Question 7

What color is the baby in VSD?

Answer 7

Pink with respiratory distress and tachycardia

Question 8

What is the implication of prominent vasculature in a CXR?

Answer 8

Congestion, lots of blood

Question 9

What are symptoms of myocarditis?

Answer 9

Vague friction rub hardly heard, EKG of inverted T waves and small QRS.

Question 10

What is the treatment for cardiac failure due to VSD?

Answer 10

High calorie diet. Digoxin, diuretics, ACE inhibitors. Can wait for VSD to close by itself if these help. Surgery if not.

Question 11

What is the first action for low O2 sat and a blue baby:?

Answer 11

Oxygen. If sat increases, was respiratory, not cardiac, more common.

Question 12

How is aortic stenosis ruled out with hypoxia?

Answer 12

Peripheral pulses

Question 13

What is the treatment for Tetrology of Fallot?

Answer 13

Prostaglandins to leave PDA open, surgery. If not duct dependent because pulmonary stenosis is not bad can wait for surgery. If transposition of great vessels need to do surgery quickly so LV doesn’t atrophy.

Question 14

What is a Tet spell caused by?

Answer 14

Tightening of the tissue right below the pulmonary trunk during irritability and crying. Leads to a right-left shunt and no blood getes to the pulmonary circulation.

Question 15

What does squatting do in a Tet spell?

Answer 15

Increases preload to the heart

Question 16

What is the treatment for a Tet spell?

Answer 16

Knee-chest position, morphine, beta blockers (dilates pulmonary arteries and muscles of infundibulum, can be prophylactic before surgery), oxygen (opens arteries but doesn’t increase O2 sat much)

Question 17

What happens if surgery isn’t performed on a ToF patient with Tet spells?

Answer 17

Convulsions, syncope, brain damage

Question 18

What causes a systolic and diastolic murmur and pink when born and late cyanosis?

Answer 18

Cardiac cushion defect/VSD/ASD/AV canal

Question 19

What increases incidence of AV canal?

Answer 19

Down syndrome

Question 20

Treatment of AV canal/Cardiac cushion defect

Answer 20

First treat infection, give O2 and CHF drugs, high caloric diet, wait until better for surgery. Surgery to build valves and septum between two ventricles and atrium.

Question 21

Side effects of building cardiac cushion

Answer 21

Mitral and TCV regurgitation. The former will likely cause HF.