Block 5 Flashcards
Pediatric cardiology history taking includes the following:
A. History of maternal rubella infection
B. History of stroke in the patient
C. Family history of congenital heart disease
D. All
D. All
Rationale:
▪Maternal rubella infection during the first trimester of pregnancy commonly results in multiple anomalies,including cardiac defects.
▪Stroke – embolization or thrombosis secondary to cyanotic CHD/IE
▪The incidence of CHD increases from about 1% in the general population to as much as 15% if the mother hasCHD, even if it is postoperative.
Pediatric Cardiology History
▪Age-specific (Many symptoms of heart failure in infants and children are age specific)
▪Prenatal and post-natal history
▪Family History Congenital Heart Disease, rheumatic fever, idiopathic sudden death
1-year-old girl was brought to the outpatient clinic due to history of interrupted feeding since birth, recurrent coughsince she was 5 months old, poor weight gain and the presence of cardiac murmur upon auscultation. The followingare the differential diagnosis:
A. Severe Pulmonary Stenosis
B. TOF
C. PDA
D. All
B. TOF
Rationale:
All of the choices present with cardiac murmur. Although only TOF presents with feeding difficulty thus poor weight gain.
Congenital heart disease or congenital heart defect, is a heart abnormality present at birth. Symptoms may not appear until shortly after birth. Children may experience: cyanosis, trouble breathing, feeding difficulties, low birth weight and delayed growth. Auscultation of a cardiac murmur consistent with structural heart disease.
True of Congestive Heart Failure:
A. Early signs of CHF may be wheezing and cough at night
B. Puffy eyelids may be secondary to pulmonary congestion
C. Ankle edema in infants
D. All
A. Early signs of CHF may be wheezing and cough at night
Rationale:
Signs and symptoms of CHF include wheezing and cough. Ankle edema is a sign BUT is very rare in infants.
Cardiac causes of chest pain include the following:
A. Acute costochondritis
B. Severe aortic stenosis
C. Obstructive sleep apnea syndrome
D. All
B. Severe aortic stenosis
Rationale:
Cardiac chest pain- usually seen in AS, PVOD, MVP.
▪Costochondritis is an inflammatory process of the costochondral or costosternal joints that causes localizedpain and tenderness and is non-cardiac in origin. Obstructive sleep apnea (OSA)—also referred to as obstructive sleep apnea-hypopnea—is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort. It has many causes, most common is obesity, and may not be in cardiac origin.
A 1-month-old was brought to the emergency room due to history of cyanosis, interrupted feeding, and recurrentrespiratory infection. On PE, there was presence of sweating on the forehead, and on auscultation a grade 3/6 holosystolic murmur at the 4th left intercostal space parasternal border. Differential diagnosis includes:
A. TOF with severe pulmonary stenosis
B. Pulmonary valve atresia
C. D-transposition of great arteries with large ventricular septal defect
D. All
C. D-transposition of great arteries with large ventricular septal defect
Rationale:
History of Moderate to Large VSD includes Dyspnea, Tachypnea, Difficulty in Feeding, Delayed Growth and Development, Repeated Respiratory Tract Infections, CHF in Infancy.
▪Severe cyanosis occurs within hours of birth, followed rapidly by metabolic acidosis secondary to poor tissue oxygenation. Patients with a moderate or large atrial septal defect, a large ventricular septal defect, a patent ductus arteriosus, or a combination of these tend to have less severe cyanosis, but symptoms and signs of heart failure (eg, tachypnea, dyspnea, tachycardia, diaphoresis, inability to gain weight) may develop during the first weeks of life.
▪There is a prominent impulse at the lower left sternal border (the right ventricle which is actually the morphologic left ventricle).
▪A VSD murmur (holosystolic) is absent at birth, until the pulmonary vascular resistance decreases. A subsequent increase in pulmonary resistance shortens and later abolishes the murmur.
True of 3rd Heart Sound:
A. Heard best at the 2nd ICS Left parasternal border
B. High frequency sound in early diastole
C. Related to rapid filling of the ventricle
D. All
C. Related to rapid filling of the ventricle
Rationale:
▪Rapid ventricular filling during early diastole.
▪Low-frequency, heard with the bell of the stethoscope at the apex or LLSB.
True of 4th Heart Sound:
A. Related to atrial contraction
B. Low frequency sound of late diastole
C. Always pathologic
D. All
D. All
Rationale:
4th Heart Sound:
▪Associated with rapid filling of the ventricle during atrial contraction (CHF, cardiomyopathy)
▪Low-frequency at the end of the diastole
▪Always abnormal
True of Innocent Murmur:
A. Common in childhood
B. Pulmonary flow murmur of newborn
C. Functional heart murmur
D. All
D. All
Rationale:
Innocent heart murmurs are harmless sounds made by the blood circulating normally through the heart’s chambers and valves or through blood vessels near the heart. They can be common during infancy and childhood and often disappear by adulthood. They’re sometimes known as “functional” or “physiologic” murmurs.
Which is TRUE of Infective Endocarditis:
A. Common in infants with congenital heart disease
B. Infective Endocarditis prophylaxis is needed to those with mild valvular hear disease prior to dental procedure
C. It doesn’t occur in children without any abnormal cardiac valves or cardiac malformation
D. All
B. Infective Endocarditis prophylaxis is needed to those with mild valvular heart disease prior to dental procedure
Rationale:
Children who have congenital heart defects are recommended for IE prophylaxis before dental procedures.
▪A. Endocarditis is rare in infancy; it usually follows open heart surgery or is associated with a central venous line. In infants with congenital heart disease prophylaxis is needed
▪B. Procedures for which IE prophylaxis is needed - dental - respiratory tract procedure - GI and genitourinary procedures
▪C. A complication of congenital or rheumatic heart disease but can also occur in children without any abnormal valves or cardiac malformation.
▪D. All - X
A 3-year-old girl was brought to the emergency room for admission due to high grade fever for 7 days duration,associated with polymorphous truncal rashes, arthralgia and bilateral conjunctival infection without exudates. The most likely diagnosis would be:
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. All
C. Kawasaki disease
Clinical Manifestations of KD
Fever – 5 days or more
5 principal clinical criteria:
1. Bilateral non-suppurative conjunctivitis
2. Oral lesions – strawberry tongue, dry reddish
cracked lips
3. Cervical lymphadenopathy - usually, it is unilateral of >1.5cm
4. Extremity changes - Erythema of palms and soles, indurative edema and desquamation of fingers and toes
5. Polymorphous truncal rash -most common
The following statement is TRUE of 2015 Modified Jones Criteria:
A. It can give the prognosis and outcome of the disease
B. Use to establish initial attack of acute rheumatic fever
C. Cannot be used to diagnose inactive or chronic RHD
D. All
B. Use to establish initial attack of acute rheumatic fever
Rationale:
Revised Jones Criteria for 2015 by AHA -Intended for diagnosis of initial attack of ARF and recurrent attack. Separate criteria for low risk populations and moderate to high risk populations.
Which of the following statement is TRUE about arthritis in Rheumatic Fever?
A. It is non-migratory in nature
B. There is an inverse relationship between severity of arthritis and severity of cardiac involvement
C. Almost causes deformity
D. All
B. There is an inverse relationship between severity of arthritis and severity of cardiac involvement
Rationale:
▪Migratory in nature.
▪Become normal within 1-3 days without treatment.
▪Dramatic response to low dose salicylates.
▪Almost never deforming compared to arthritis in other connective tissue diseases like the juvenile rheumatoid arthritis.
▪Inverse relationship between severity of arthritis and severity of cardiac involvement.
A 5-year-old boy was brought to the OPD for consultation due to HG Fever, bilateral non-purulent conjunctivitis,redness of the lips and tongue, periungual edema, polymorphous truncal rashes. The following will be the diagnosis:
A. Kawasaki disease
B. Steven Johnson Syndrome
C. Scarlet fever
D. All
A. Kawasaki disease
Rationale:
The case mentioned above is suggestive of Kawasaki Disease. Diagnosis of Kawasaki disease requires the presence of fever and 4 out of 5 of these clinical manifestations. B and C are Differentials for Kawasaki disease.
The following are the primary determinants of stroke volume, EXCEPT:
A. Intrinsic myocardial function
B. Oxygen carrying capacity
C. Preload or volume work
D. Afterload or pressure work
B. Oxygen carrying capacity
Rationale:
Stroke volume index is the volume of blood pumped by the heart with each beat (in milliliters) divided by the body surface area (square meters). This allows direct comparison of the stroke volume index of large and small patients. Stroke volume index is determined by three factors:
▪Preload: The filling pressure of the heart at the end of diastole.
▪Contractility: The inherent vigor of contraction of the heart muscles during systole.
▪Afterload: The pressure against which the heart must work to eject blood during systole.
Starling’s Law is the relationship between preload and stroke volume.
