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If a murmur is heard in an infant, what 2 important history parts should you asked?
- 1. Weight gain/development
- 2. Feeding patterns
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What are 3 main components of a PE for a murmur?
- 1. General appearance
- 2. Pulmonary exam
- 3. Abdomen
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What pulse ox level may be considered abnormal?
<94%
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Where should the PMI be felt?
4th/5th ICS, midclavicular line
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Bradycardia might be a sign of: (3)
- 1. heart block
- 2. systemic dx
- 3. medication
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Tachycardia may be a sign of: (5)
- 1. systemic illness
- 2. fever
- 3. heart failure
- 4. anemia
- 5. arrhythmias
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The bell of stethscope hears high or low frequency? diaphragm hears high or low?
- Bell--> low frequency
- Diaphragm--> increase frequency
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What are the 2 "normal" cardiac sounds?
S1, S2
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The 1st sound is closure of which valves?
-tricuspid & mitral
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The 2nd heart sound is closure of which valves?
-aortic & pulmonary valve
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When is a physiologic splitting of P2 (pulmonary valve) heard?
-With inspiration, negative intrathoracic pressure
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What is signficant about a 3rd heart sound?
- -low frequency sound, early diastole
- -r/t to rapid diastolic filling of ventricle
- -Abn loud S3--> CHF, large shunt
- -KENTUCKY
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What is signficant about 4th heart sound?
- -Low frequency in LATE diastole
- -Decreased ventricular compliance
- -TENNESSEE--> rare in kids
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What is signficant about a heart "click"?
- -onset of systolic ejection period, opening of semilunar valves
- -audible at base (like split S1)
- -Valvar stenosis/dilated great arteries
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What are the 7 parts to describing a mumer?
- 1. intensity
- 2. classification
- 3. pitch
- 4. quality
- 5. location
- 6. radiation/transmission
- 7. provocative maneuvers
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What grade is a murmur when a "thrill" is present?
Grade IV
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T or F. Systolic murmers are always pathological.
FALSE (diastolic are always pathological)
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When ages are innocent murmers most common?
age 2-5yo
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What 6 types of murmers always need to be referred?
- 1. diastolic
- 2. associated with thrill (4 or >)
- 3. Regurgitant murmur
- 4. Abnormal heart sounds
- 5. Abnormal pulses
- 6. symptomatic
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What is the most important tool for assessing palpitations?
History
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What are 2 red flags for arrhythmias?
- 1. previous surgery
- 2. palpitations
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What may be the best electrical tool for getting a child's rhythm strip?
Loop monitor
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When should an electrophysiology study be used?
Last ditch
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T or F. If has palpitations r/t to SVT, diagnosis could take months to years.
True
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What lab should be checked for kids with palpations?
Thyroid, TSH
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What are the 6 causes of chest pain in kids?
- 1. Anxiety
- 2. pulmonary
- 3. MSK
- 4. GI
- 5. Heart
- 6. Idiopathic
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What are the 2 causes of cardiac chest pain?
- 1. Imbalance of myocardial oxygen supply
- 2. Irritation of pericardial serosa
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What structural abnormalities are associated with chest pain?
- 1. Left ventricular outflow obstruction (aortic stenosis, obstr cardiomyopathy)
- 2. Mitral valve prolapse
- 3. coronary artery anomalies
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Name 4 acquired myopericardial or coronary artery diseases.
- 1. Myocarditis
- 2. Pericarditis
- 3. Kawasaki dx
- 4. Coronary arteritis/aneurysms
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What is the history assessment for chest pain (QRST)
- Q-quality
- R- radiation
- S- severity
- T- temporal
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T or F. Chest pain in children and adolescents is a frequent but most often benign complaint.
True
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What are some factors that may indicate organic etiology for chest pain?
- -younger age
- -acute-onset
- -pre-existing medical conditions
- -abnormal hx/PE
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T or F. A consistently split S2 should be referred?
True
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During physiologic split of S2, the P2 is wider from A2 during expiration or inspiration?
Inspiration
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In S2, the A2 is louder or softer than P2?
A2 is louder and fixed, P2 is softer and varies with inspiration
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A "narrow split" of S2 can suggest what 2 disorders?
- 1. Pulmonary HTN
- 2. Aortic stenosis
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A "wide split" of S2 can suggest a prolonged RV ejection or shortened LV ejection. This sound can be associated with what 3 disorders?
- 1. Volume overload
- 2. pulmonary stenosis
- 3. Right bundle branch block: delayed activation
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A midsystolic click is suggestive of? (2)
- 1. Mitral valve prolapse
- 2. Tricuspid valve prolapse
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Discuss an ejection click.
- - Onset of systolic ejection period
- -audible at BASE (unlike split S1)
- -Secondary to:
- -Valvar stenosis
- -dilated great arteries
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A systolic murmer that is louder and shorter during ejection is associated with:
Stenotic valve
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A systolic murmur that same intensity through murmur is suggestive of what kind of valve?
Leaky valve
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Prediastolic murmers are associated with what?
True mitral or tricuspid stenosis
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Mid-diastolic rumble is turbulence across the AVV and suggestive of:
-anatomic or volume related stenosis
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Symptoms that may be suggestive of innocent murmurs are:
Murmurs that are accentuated with increased output--> fever, anemia, exercise, anxiety
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