Read Online Pediatric Examination and Board Review by Robert Daum, Jason Canel - Free Book Online Page B
Authors: Robert Daum, Jason Canel
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because of a bicuspid aortic valve and coarctation of the aorta are commonly seen in patients with Turner syndrome, and left ventricular outflow tract obstruction may be seen in patients with severe forms of hypertrophic cardiomyopathy. The typical examination feature in a patient with mitral valve prolapse includes a systolic ejection click that varies in timing when the patient is standing versus when he is squatting. A diastolic murmur of mitral regurgitation may be heard in conjunction with more severe cases of mitral valve prolapse.
15. (D) In patients with Marfan syndrome, participation in activities is limited to mildly aerobic low-impact sports. This is to avoid precipitation of further aortic root dilation or rupture and to avoid retinal detachment. It is recommended that patients with Marfan syndrome undergo routine echocardiographic evaluation to assess aortic root dilation as well as routine ophthalmologic examinations. Betablockers are effective to decrease the progression of aortic root dilation.
16. (A) The American Heart Association recommends that a preparticipation physical examination screening include obtaining a family history for sudden cardiac death and a review of systems looking for a history of dizziness or syncope. Physical findings of Marfan syndrome, hypertension, decreased peripheral pulses, or a pathologic murmur such as the harsh systolic murmur described would indicate the need for further evaluation. The finding of a family history of diabetes, respiratory, sinus arrhythmia, or a single elevated blood pressure returning to normal at subsequent visits would not place this patient at risk for sudden death during sports.
S UGGESTED R EADING
Allen HD, Driscoll DJ, Shaddy RE, Feltes TF, eds. Moss and Adams Heart Disease in Infants, Children and Adolescents. 7th ed. Philadelphia, PA: Williams and Wilkins; 2007.
Braunwald E, Zipes DP, Libbey P, eds. Braunwald: Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, PA: WB Saunders; 2004.
Keane JF, Fyler DC, Lock JE, eds. Nadas’ Pediatric Cardiology. 2nd ed. Philadelphia, PA: Hanley and Belfus; 2006.
Park M, ed. Pediatric Cardiology for Practitioners. 5th ed. St. Louis, MO: Mosby; 2007.
Chapter 2
CRITICAL CARE
CASE 6: A 5-MONTH-OLD WITH APNEA AND CYANOSIS
A 5-month-old male infant is brought to the emergency department after he “stopped breathing for approximately 20 seconds and became blue around his lips.” He began breathing again after the mother “blew in his face.” There have been no other symptoms such as upper respiratory tract illness, fever, vomiting, diarrhea, or change in eating habits. He takes approximately 28-34 ounces of formula per day as well as some solids and has always eaten well, although he often “spits up” after eating.
When you first see this child, he is somewhat irritable. His physical examination is completely normal except that there is dried blood in both of the child’s nares. His room air oxygen saturation is 98%. It has been approximately 90 minutes since the baby “turned blue,” and the mother appears to be quite frightened by these events.
The family history is remarkable for a sibling’s death during sleep 2 years ago, subsequently labeled as so-called SIDS (sudden infant death syndrome).
SELECT THE ONE BEST ANSWER
1. The screening test(s) that need to be performed emergently include(s)
(A) serum glucose and electrolytes
(B) a complete blood count (CBC) and differential
(C) an erythrocyte sedimentation rate and serum C-reactive protein (CRP) level
(D) examination of cerebrospinal fluid (CSF)
(E) a computed tomography (CT) scan of the head
2. In addition to the stat screening test performed in question number 1, the initial workup should also include
(A) a CT scan of the head, chest radiograph, and electrocardiogram (ECG)
(B) an esophageal pH probe, thyroid functions, and an EEG
(C) an echocardiogram, head CT, and thyroid function tests
(D)
15. (D) In patients with Marfan syndrome, participation in activities is limited to mildly aerobic low-impact sports. This is to avoid precipitation of further aortic root dilation or rupture and to avoid retinal detachment. It is recommended that patients with Marfan syndrome undergo routine echocardiographic evaluation to assess aortic root dilation as well as routine ophthalmologic examinations. Betablockers are effective to decrease the progression of aortic root dilation.
16. (A) The American Heart Association recommends that a preparticipation physical examination screening include obtaining a family history for sudden cardiac death and a review of systems looking for a history of dizziness or syncope. Physical findings of Marfan syndrome, hypertension, decreased peripheral pulses, or a pathologic murmur such as the harsh systolic murmur described would indicate the need for further evaluation. The finding of a family history of diabetes, respiratory, sinus arrhythmia, or a single elevated blood pressure returning to normal at subsequent visits would not place this patient at risk for sudden death during sports.
S UGGESTED R EADING
Allen HD, Driscoll DJ, Shaddy RE, Feltes TF, eds. Moss and Adams Heart Disease in Infants, Children and Adolescents. 7th ed. Philadelphia, PA: Williams and Wilkins; 2007.
Braunwald E, Zipes DP, Libbey P, eds. Braunwald: Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia, PA: WB Saunders; 2004.
Keane JF, Fyler DC, Lock JE, eds. Nadas’ Pediatric Cardiology. 2nd ed. Philadelphia, PA: Hanley and Belfus; 2006.
Park M, ed. Pediatric Cardiology for Practitioners. 5th ed. St. Louis, MO: Mosby; 2007.
Chapter 2
CRITICAL CARE
CASE 6: A 5-MONTH-OLD WITH APNEA AND CYANOSIS
A 5-month-old male infant is brought to the emergency department after he “stopped breathing for approximately 20 seconds and became blue around his lips.” He began breathing again after the mother “blew in his face.” There have been no other symptoms such as upper respiratory tract illness, fever, vomiting, diarrhea, or change in eating habits. He takes approximately 28-34 ounces of formula per day as well as some solids and has always eaten well, although he often “spits up” after eating.
When you first see this child, he is somewhat irritable. His physical examination is completely normal except that there is dried blood in both of the child’s nares. His room air oxygen saturation is 98%. It has been approximately 90 minutes since the baby “turned blue,” and the mother appears to be quite frightened by these events.
The family history is remarkable for a sibling’s death during sleep 2 years ago, subsequently labeled as so-called SIDS (sudden infant death syndrome).
SELECT THE ONE BEST ANSWER
1. The screening test(s) that need to be performed emergently include(s)
(A) serum glucose and electrolytes
(B) a complete blood count (CBC) and differential
(C) an erythrocyte sedimentation rate and serum C-reactive protein (CRP) level
(D) examination of cerebrospinal fluid (CSF)
(E) a computed tomography (CT) scan of the head
2. In addition to the stat screening test performed in question number 1, the initial workup should also include
(A) a CT scan of the head, chest radiograph, and electrocardiogram (ECG)
(B) an esophageal pH probe, thyroid functions, and an EEG
(C) an echocardiogram, head CT, and thyroid function tests
(D)
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