desaisa's version from 2015-10-04 23:40

Cyanotic heart defects

defectphysical examdiagnosticstreatmentfun facts
ToFRV impulse, single S2, systolic ejection murmur at LUSBboot shaped heart, decreased pulm vasculature, right aortic archblalock-taussig shunt, then 1) close VSD, 2) relieve RVOTO, 3) ligate shunts 4) close PFOmaternal rubella/ viral illness
Transposition of great vesselsearly cyanosis, single S2, no murmur,normal CXR, then RVH at one month = "egg on a string"need PDA - give PGE1, early atrial septostomyif VSD, then little cyanosis, can go directly to repair
truncus arteriosussingle prominent S2, systolic ejection click, bounding peripheral pulsescardiomegaly, inc pulmonary markingssurg at 3-4 mo, close VSD, Rastelli repairtruncus overrides a VSD
Hypoplastic left heartnormal to absent pulses, single S2, hyperdynamic RV pulse characteristic graish pallorcardiomegaly with globular shaped heart, pulm vascularityNorwood, Glenn, Fontan then transplant
TAPVR + obstructionno murmur, hepatomegalynormal heart, pulm edemaballoon atrial septotomyhigh pulm A pressure, cyanosis
TAPVR without obstructionlater presentation with FTT, right heart failureLarge PA = snowman heartsurgical correctionfree communication between the RA and the LA
Ebstein's anomalyfixed S2 split, holosystolic murmur at LLSB, CHF in first six monthstricuspid valve is displaced into RV and non functional, RA is large and RV sucksballoon shaped/ wall to wall heart RBBB, WpWglenn procdure, reconstruction

Valvualr heart Defects

Tricuspid atresiano tricuspid valve, ASD or VSD,75% will be cyanotic in the first week. LV impulse laterally deviatedEKG = LVHPGE for ductal patency, surgery, glenn, fontan
Pulmonary atresiabad when ventricular septum is intact. death if PDA closescyanosis within hours of birth, single S2, holosystolic murmurnormal CXR, maybe big RVPGE1, atrial septotomy
aortic stenosisbicuspid valves!older kid with chest pain, syncope, DEATH. crescendo/decrescendo murmur +/- systolic ejection clickneed an echo, periodvalvotomy based on gradient

Acyanotic defect

ASDwide/fixed S2 split, pulmonary flow murmurEKG right atrial enlargement, RVHif <3mm - close spontaneously. if > 8 mm need surgical closure
VSDholosystolic murmur. low pitch = small VSD, high pitch = large VSDLVH, cardiomegalywatch until CHF, then fixendocarditis prophylaxis
PDAmachinery murmur, bounding peripheral pulses, wide pulse pressure; lower resp infections, endocarditis- Indomethacin in preemies, if older cather closureleft-right shunting leading to RDS! duct does not close in response to O2. more common in HIGH altitudes due to low O2 tension
coarctation of the aortaupper extremity HTN, lower extremity weakness 3 sign on CXRresection of coart, allograft augmentation, catheter dilation

Guess the TORCH infection


intracranial calcifications, chorioretinitis, microcephaly, LA, hyperbili, TCPtoxoplasmosis75% are asx
fever, mucocutaneous lesions,osteitis, osteochondritis, persistent rhinitissyphilis
cataract, glaucoma, deafness, cardiac defects, blueberry muffin rashcongenital rubellaIg doesnt help
encephalitis, chorioretinitis, normal head sizeHSVusually transmitted at birth = normal head size
chorioretinitis, IUGR, MR, vision changes, periventricular calcificationsCMVgancyclovir

fun facts

Question Answer
most common presentation 2-6 months of ageToF
most common heart defect presenting in neonatestransposition
second most common presenting in first week of lifeHLH
most common heart defectVSD
most common defect seen in adultsASD
maternal rubellaPDA, ToF
big blue babytransposition - has normal intrauterine growth
dyspnea, respiratory infections, FTT, later cyanosis(once PVR inc)truncus arteriosis
25% of cardiac deaths in first year of lifeHLH
cyanosis restricted to the lower extremitiesEisenmengers + PDA
most common ASDsecundum - central portion

Social Milestones

Question Answer
Spontaneous Smilebirth - 4 weeks
Social Smile1-2 months - 6-8 weeks
works for toy3-5 months
feeds self4-6 months
responds to image in mirror5-6 months
plays ball with examiner9-12 months
uses utensils12-18 months
feeds doll15-18 months (at least 1.5yrs old)
points to nose, eyes, ears18 months
takes off shoes and socks18 months
puts on an article of clothing20-25 months (older than 1.5 years)
cooperative play, imaginary play, taking turns3 years
able to play simple board/ card games3-5 years


Question Answer
recognizes parents2 months
strangers recognize ( anxiety)6 months
peek-a-boo9 months
plays pat-a- cake9-12 months
waves bye-bye9 -12 months
imitates actions12 months
can be beckoned12 months
hugs parents, gives affection15 months


Question Answer
Plays with other kids18 months
parallel play24 months
knows own gender3 years

Fine Motor Skills

Question Answer
tracks to midlineat birth
tracks past midline1-3 months
transfers large objects from one hand to another6 months


Question Answer
manipulates 2 objects at once12 months
reaches4-6 months
raking grasp6 months
rough pincer grasp7-9 months
can uncover hidden toy (object permanence)10 months
unassisted pincer12 months
holds own bottle9 months
washing/drying hands24 months
brushing teeth with help24 months


Question Answer
tower of 2-3 cubes 15 months
tower of 4 cubes18 months
tower of 6-7 cubes 2 years
tower of 10 cubes3yrs
imitates 3 cube bridge3yrs
5 cube gate4 yrs


Question Answer
folds paper once (imitation)2 yrs
turns pages of a book2 years
can identify picture2 years


Question Answer
scribbles18 months
copies a vertical line 18 months
Copies a horizontal line2 years
imitates circular stroke2yrs
copies a circle2.5-3 years
imitates a cross 3 yrs
copies a cross3.5 -4 years
copies a square4 - 4.5 years
copies a triangle5y
draws a man4 years


Question Answer
Vocalizing1 month
Babbling/ polysyllabic vowel sounds6 months
non specific mama, polysyllabic consonants9 months
Mama / Dada - specific to a person12 months
One additional word (2 words total)(1 year)
10 words18 months
using 2 word phrases(17-20 months)
puts together 3 words2 yrs
obeys one step commands1 year
obeys 2 step commands2 years
50 % understandable17 - 30 months (2 years)
75% understandable3 years
100% understandable4 years


Question Answer
responds to name15 months
points to body parts18 months
knows full name30 months
understands pronoun 'I'30 months
knows age3 yrs
knows sex3 yrs


Question Answer
points to pictures24 months
asking questions3 years
can tell a story4 yrs
30-50 words2 years
using plurals3 years


Question Answer
repeats three numbers 3yrs
counts to 33 yrs
Counts to 54 years
counts to 105 years
counts to 306 years

Gross Motor

Question Answer
Lifting head from pronenewborn
lift head to 452 months
Holds head3 months
lift head to 902-4 months (4 months)
Chest up with arm support3-4 months (4 months)
rolls over ( 4 months ) 2-5 months
Sits with head steady2-3 months (3 months)
sits with no support6 months
gets to sitting8-9 months
cruising10-11 months
walking11-15 months


Question Answer
throwing ball overhead18 months
kicks ball forward24 months
rides tricycle3 years
small jumps2 years
hops3-4 years
stands on one foot5 years
heel to toe walking4-6 years


Question Answer
stoop and recover15 months
creeping up stairs15 months
stairs one step at a time2 years
stairs - one foot per step3 years
walking up stairs with hand held18 months
climbing down stairs4 years


Question Answer
can hold a toy placed in hands3 months
regards toy and takes it to the mouth4 months
hands activate when see a toy4 months
feet go to the mouth5 months

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