CMN 574 UNIT 3 ADHD/Eating Disorders/Child & Elder Abuse/Substance Abuse/CHD EXAM.

Most common congenital heart malformation VSD Window for spontaneous closure of PDA Up to age 1 year. Spontaneous closure after that age is rare. Leading cause of HF in 1st month of life Coarctation of aorta - either alone or in combination with ASD, VSD or other cardiac anomalies. Syndrome commonly seen in female patients with coarctation of the aorta? Turner's Syndrome Features of tetralogy of fallot 1) Pulmonary stenosis 2) RV hypertrophy 3) Overriding aorta 4) VSD Presentation of tetralogy of fallot + Hypoxemic spells during infancy ("Tet spells", around 4 - 6 months) + Cyanosis at birth or by 4 months + Clubbing of fingers and toes + Elevated H&H and RBC due to chronic arterial desaturation NOTE: 2 dimensional imaging is diagnostic What is the leading cause of acquired heart disease in children in the US? Kawasaki disease. Diagnostic criteria for Kawasaki disease High fever for at least 5 days, plus 4 of 5: - changes in oral mucosa - extremity changes (redness/swelling/desquamation) - unilateral cervical lymphadenopathy (least likely to be present) - rash - bilateral, non-exudative conjunctivitis Median age of diagnosis for Kawasaki disease + 80% are younger than 5 yrs + Median age is 2 yrs Treatment of Kawasaki Disease IVIG, high-dose aspirin Most common causes of pericarditis in children VIRAL infections (e.g. coxsackievirus, mumps, epstein-barr, adenovirus, influenza and HIV) Presentation of pericarditis in children + Sharp, stabbing chest/shoulder/neck pain made worse by deep inspiration and decreased by leaning forward Most common cause of chest pain in children inflammation of musculoskeletal structures of chest wall. When would you suspect bacterial endocarditis in a child with congenital heart disease? Prolonged fever without a known cause Diagnostic criteria for rheumatic fever? Two major OR one major and two minor: MAJOR + Carditis + Polyarthritis + Cydenham chorea + Erythema marginatum + Subcutaneous nodules MINOR + Clinical -- Previous rheumatic fever or rheumatic heart dz, polyarthralgia, fever + Lab - ↑ ESR, CRP, leukocytosis; prolonged PR interval; PLUS evidence of previous strep infection. What gradient BP difference Between upper and lower extremities would make you suspect coaction of the aorta? ≥ 20 mm/Hg higher in UPPER extremities What can be used to close a PDA? Indomethacin Heart defect associated with split s2? Where is it heard? ASD, heard at LL sternal border ______ age group has a dull thick hymen; ______ age group will have thin, reddened, sensitive vaginal mucosa Newborn -- dull and thick Pre-pubertal -- thin, reddened, sensitive What's the best position to perform a pediatric rectal exam? Supine knee chest What are the treatment options for labial fusion? If it's mild there is no treatment. You might have to treat for a UTI though. -Otherwise, premarin cream According to Korn: what's the ideal amount of time to collect evidence after sexual assault? 72 hours Most common bacterial organism and treatment recommendations for vulvovaginitis? Organism: GABHS -Tx: Pen VK, bactroban (plus topical nystatin if candidiasis present) BED pt with Hx of serotonin syndrome on Prozac as a teenager. What could you rx to encourage binge remission? Topamax BED pt with Hx of serotonin syndrome on Prozac as a teenager. What could you rx to encourage binge remission? Topamax Anogenital molluscum contagiosum in children + Not related to sexual contact, but associated with swimming pool use, skin to skin contact, sharing of fomites + Small, single or multiple umbilicated papules (2 - 4 mm) with a white, waxy core. Factors that increase concern for sexual abuse as factor in perineal straddle injury sx 1) No hx of injury 2) 9 months or non-ambulatory 3) Perineal, vaginal or hymenal injury without hx of penetrating trauma 4) Extensive or severe trauma 5) Presence of non-urogenital trauma 6) HIPF Tx of urethral prolapse Sitz baths or estrogen cream Presentation of a small VSD + Small hole - Turbulence - LOUD murmur (+ thrill sometimes) + Shape = Holosystolic 3 causes of holosystolic murmur + Mitral regurgitation + Tricuspid regurgitation + Ventricular septal defect -NOTE: Only the VSD patient will not be SICK when you hear the murmur. Quality of a PDA + CONTINUOUS machine-like murmur + Heard in both systole AND diastole, which distinguishes it from other murmurs which are only in one part of the cycle. You rx a stimulant to a 10 yo boy for ADHD after neuropsych w/u. What are you monitoring on him at each visit? SATA a) HR & BP, b) vision & hearing, c) weight & height, d) all of the above, e) a & c. VSD is a congenital defect most commonly associated with: a) Down syndrome, b) Fetal etoh syndrome, c) gestational DM, d) congenital rubella. PDA is a defect most commonly associated with: a) Down syndrome, b) Fetal etoh syndrome, c) gestational DM, d) congenital rubella. ASD is a heart defect most commonly associated with: a) Down syndrome, b) Fetal etoh syndrome, c) gestational DM, d) congenital rubella. Which heart condition is oft associated with Turner's? a) PDA, b.) tricuspid atresia, c) truncus arteriosus, d) tet of fallot. Which of the following are NOT part of the dx criteria for anorexia nervosa? a) intense fear of wt gain, b) significantly low weight, c) severe body image disturbance, d) absence of menstrual cycle. A pt who abuses alcohol with probably exhibit: a) elevated alkaline phosphatase, b) decreased TSH, c) elevated ALT, AST, and GGT, d) elevated AST only. Which of the following is true about elder abuse and neglect? (SATA) a) it is always physical, b) the elder will always be willing to tell the provider what is happening, c) it can be financial, physical, or emotional, d) is a contributor to poor nutritional status, e) is suspected if the "story" does not fit the injury or concern. Which of the following ADHD meds are not classified as an amphetamine/stimulant? a) dexmethylphenidate, b) mixed salts of amphetamine, c) methylphenidate, d) atomoxetine.