26th DAY OF PEDIATRICS | clinical tutorial Step 1 of 11 0% PHYSICS 1o Incident Term infant, 6 weeks old,BG 3.6 kg, no audible murmur at birth, 3/6 holosystolic murmur at the top of the heart , femoral normal, 55 breaths/minute, 160 beats/minute, BG 4.2 kg, slight feeding fatigue, not breastfed.1.1 What will be your next move?(Required) Re-examination in 2 weeks; if murmur persists refer to a paediatric cardiologist Immediate referral to an on-call hospital - possible congenital heart disease Reassuring parents and referral to a second year - the murmur was not heard at birth so it is probably innocent I suspect congenital heart disease and refer to a paediatric cardiologist but the referral is not urgent on the same day 1.2 What is the most likely diagnosis?(Required) Aortic isthmus stenosis Interventricular Communication Respiratory infection Open Arterial Port 2o Incident Term infant , 8 weeks old for the first vaccine, BW 3 kg, syndromic features, 2/6 systolic extrathoracic murmur, audible from birth in the second intercostal space on the left, femoral cfs, 40 breaths/minute, 120 bpm, BG 5 kg, SatO2 99%2.1 What will be your next move?(Required) Re-examination in 2 weeks; if murmur persists refer to a paediatric cardiologist Immediate referral to an on-call hospital - possible congenital heart disease Reassuring parents and referral to a second year I suspect congenital heart disease and refer to a paediatric cardiologist but the referral is not urgent on the same day 2.2 What is the most likely diagnosis?(Required) Interventricular Communication Pulmonary stenosis Aortic valve insufficiency Open Arterial Port 3o Incident Premature neonate, birth 2/6 continuous murmur, normal femoral arteries, BP 2 KG, 3 days old, no continuous murmur, difficulty palpating femoral arteries, SatO2 88%3.1 What will be your next move?(Required) Direct Prostaglandin Start Immediate pharmaceutical attempt to close the resource Reassurance since I don't hear constant blowing and simple monitoring Immediate oxygen administration and infection control 3.2 What is the most likely diagnosis?(Required) Interventricular Communication Pulmonary stenosis Aortic valve insufficiency Open Arterial Port 4o Incident 9 year old boy, fever, feeling fatigued during exercise with a history of asthma, A/E : 1/6 systolic murmur and 2/4 diastolic murmur in the right second intercostal space, normal femoral arteries, BP 110/65 mm Hg, SatO2 :100%, 120 beats/minute.4.1 What will be your next move?(Required) Re-examination outside of fever - if murmur persists referral to a paediatric cardiologist in a second year Immediate referral to an on-call hospital - possible congenital heart disease Reassuring parents - innocent murmur on fever I suspect congenital heart disease but referral is not urgent on the same day 4.2 What is the most likely diagnosis?(Required) Mitral valve prolapse Pulmonary valve stenosis Bicuspid Aortic Valve with Aortic Valve Stenosis and Aortic Valve Insufficiency Innocent Blowing 5o Incident 4 year old girl, fever and cough, tachycardia, 170 beats/minute, mild tachypnea on fever, A/E :2/6 systolic murmur audible throughout the precordium, femoral palpable emphysema, SatO2: 99%.5.1 What will be your next move?(Required) Re-examination outside of fever - if murmur persists referral to a paediatric cardiologist in a second year Immediate referral to an on-call hospital - possible congenital heart disease Reassuring parents - innocent murmur on fever I suspect congenital heart disease but referral is not urgent on the same day 5.2 What is the most likely diagnosis?(Required) Mitral valve prolapse Pulmonary valve stenosis Bicuspid Aortic Valve with Aortic Valve Stenosis and Aortic Valve Insufficiency Innocent Blowing THORAKIKO ALGOS6.1 In a child with fainting, which of the following characteristics requires immediate referral for hospitalisation?(Required) Syncope in sports Syncope in an upright position after a sudden tilt Family history of aortic valve regurgitation Multiple prolific episodes in the past 6.2 What is the most common cause of chest pain in children?(Required) Musculoskeletal Contact Regression Pneumonia Coronary artery disease Myocarditis-Pericarditis APPLICATIONS1o Incident During a scheduled visit to the pediatrician in a 3-year-old child, an irregular heartbeat is detected.7.1 Which of the following possible causes needs no treatment (except confirmation by electrocardiogram)(Required) Respiratory (sinus) arrhythmia Extraordinary atrial contractions Extraordinary ventricular contractions All of the above 7.2 What laboratory tests will you request to investigate a heart rhythm disorder?(Required) General blood, CRP Biochemical tests: glucose, electrolytes (K, Na, Ca, Mg) Thyroid hormone monitoring All of the above 7.3 In which of the following situations is sporting activity NOT prohibited?(Required) Recent acute COVID-19 infection Extraordinary contractions without underlying heart disease Pericarditis Myocarditis 2o Incident A mother is calling you because her 50-day-old baby girl: she has been restless for two days, eating 60 grams of milk instead of the 120 she used to drink and today she seems lethargic.8.1 What are you thinking of doing?(Required) Give instructions over the phone Bring it to the private practice Send it to the hospital 8.2 You bring the child to the clinic. You find that he has a "sickly appearance": (he is pale, has tachypnea, tachycardia and sluggishness). You immediately take him to the hospital on call. At triage: temperature: 36,5o C, oxygen saturation (SaO2)=98%Breaths: 60/min, pulse: 250/min, absence of heartbeat(Required)What are the next immediate actions? Clinical by examination systems Blood pressure measurement Electrocardiogram All of the above A & C 8.3 After reduction to sinus rhythm: on clinical reassessment the infant remains hepatomegaly despite a reduction in the number of heartbeats and on cardiac auscultation the calpathic rhythm remains without a heart murmur.(Required)What is the possible diagnosis? Underlying congenital heart disease causing tachyarrhythmias Congestive heart failure due to tachyarrhythmia 3o Incident A 7-month-old infant is brought to the hospital due to: - Tachycardia, arrhythmia - Easy fatigue/sweating during feeding in the last period of time - Tachycardia and hypotension during the last few days: Respiratory infection two months ago.9.1 What is the most likely diagnosis?(Required) Tachycardia without underlying disease (e.g. supraventricular tachycardia) Tachycardia/arrhythmia with possible coexistence of congenital heart disease Tachycardia/arrhythmia with coexisting acquired heart disease
