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Most popular medical Questions
During physical examination, what patient maneuvers can increase the likelihood of detecting mitral valve prolapse (MVP) on auscultation?In patients with MVP, the leaflets of the mitral valve apparatus billow into the left atrium. Maneuvers that decrease LV size and volume (and thus increase the relative size of the leaflets) increase the likelihood of hearing the click or murmur. These include the straining phase of a Valsalva maneuver, inspiration, and change from a supine to a sitting position or from a squatting to a standing position. The left lateral decubitus position may also be facilitative.
How is pulsus paradoxus measured?
To measure a pulsus paradoxus, determine the systolic pressure by noting the first audible Korotkoff sound. Then retake the blood pressure by raising the manometer pressure to at least 25 mmHg higher than the systolic pressure, and allow it to fall very slowly. Stop as soon as the first sound is heard. Note that the sound disappears during inspiration. Lower the pressure slowly, and note when all pulsed beats are heard. The difference between these two pressures is the pulsus paradoxus. Normally, in children, there is an 8-10 mmHg fluctuation in systolic pressure with different phases of respiration.
Is palpation for femoral pulses a reliable screening tool for coarctation of the aorta in infants and older children?
The detection of decreased lower extremity pulses seen in coarctation can be subtle and unreliable. In some infants, a patent ductus arteriosus may provide blood flow to the lower extremities, thus bypassing a severe coarctation. Upper and lower pulses may be equal as long as the ductus remains open. As the ductus closes, signs of coarctation of the aorta may appear with respiratory distress and cardiac failure. Decreased or absent pulses may then be noted. In older children, simultaneous palpation of upper and lower extremity pulses is important. If collaterals have developed, a delay in pulse rather than diminished volume may be noted. In a study of older patients (>1 year old) with documented coarctation, only 20% had absent lower extremity pulses, and distinguishing differences between upper extremity and lower extremity pulses was unreliable. Thus, some authors recommend that screening for coarctation of the aorta be done by measuring blood pressure in both arms and one leg.
What are shunt operations?
Shunts between a systemic artery and the pulmonary artery are used to improve oxygen saturation in patients with cyanotic CHD and diminished pulmonary blood flow. Venoarterial shunts that connect a systemic vein and the pulmonary artery are also used for similar purposes.
Is there any surgical therapy for hypoplastic left heart syndrome?
In patients with this condition, severe underdevelopment of the left ventricle, mitral valve, aortic valve, and ascending aortic arch occurs. Newborns develop signs of severe CHF and cyanosis. Two surgical options are available: heart transplantation and the Norwood procedure.
What is the long-term prognosis for heart transplantation during infancy and childhood?
Survival statistics have improved dramatically over the last 10 years with the use of newer and safer immunosuppressive agents such as cyclosporine and FK506. However, children who receive transplanted hearts are at increased risk for cardiac rejection, infection, accelerated coronary artery disease, and lymphoproliferative syndromes. Recent estimated 5-year survival rates vary between 65% and 70%.
When is acne most likely to develop?
The development of micro comedones is typically the earliest sign of acne. Studies have shown that comedones occur in three fourths of premenarchal girls at an average age of 10 years and in about half of 10- to 11-year-old boys. They may herald (or predate) the onset of puberty.
How do a "blackhead" and a "whitehead" differ histopathologically?
Both lesions are produced by obstruction and distention of the sebaceous follicle with sebum and cellular debris. When the follicular contents tent the overlying skin but are not exposed to the atmosphere, a whitehead occurs. If the contents project out of the follicular opening, oxidation of the exposed mass of debris produces a color change and a blackhead.
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