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PDS > Car > Flashcards

Car Flashcards

1
Q

How many umbilical vessels are there usually?

A

2 umbilical arteries

1 umbilical vein

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2
Q

Path of umbilical artery

A

Internal iliac artery to Placenta

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3
Q

After birth, umbilical arteries become

A

Medial umbilical ligaments

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4
Q

Role of umbilical artery

A

Blood flows from fetus to placenta

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5
Q

High/low Flow and Resistance in placenta?

A

High flow, Low resistance

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6
Q

High/low Flow and Resistance in lungs?

A

High resistance, Low flow

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7
Q

Path of umbilical vein

A

Placenta to liver/portal vein and ductus venosus to IVC

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8
Q

After birth, umbilical vein becomes

A

Ligamentum teres

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9
Q

Role of ductus venosus

A

Shunt oxygenated blood from UmbV to IVC (to heart and rest of body)

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10
Q

After birth, ductus venosus becomes

A

Ligamentum venosum

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11
Q

Role of foramen ovale

A

Shunt mixed/oxygenated blood from Right heart to Left heart to bypass the lungs and to the baby’s body

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12
Q

After birth, foramen ovale becomes

A

Fossa ovalis

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13
Q

Which closes first, foramen ovale or ductus arteriosus?

A 
Foramen ovale (soon after birth)
Ductus arteriosus (approx 2 days)
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14
Q

Role of ductus arteriosus

A

Shunt mixed/oxygenated blood from Pulmonary Artery to the Aorta to bypass the lungs

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15
Q

After birth, ductus arteriosus becomes

A

Ligamentum arteriosum

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16
Q

Ductus arteriosus constricts/closes due to which 2 factors;

A

High O2 and Low prostaglandins

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17
Q

Fetal pulmonary circulation has high resistance due to

A

Hypoxic pulmonary vasoconstriction

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18
Q

After birth, umbilical vessels have high/low Flow and Resistance?

A

High resistance (vessels constrict) and hence low flow

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19
Q

Why does foramen ovale close

A

First breath leads to reduced pressure of Right heart and increased pressure of Left heart

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20
Q

Drug to keep holes patent (maintains patency)

A

Prostaglandins

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21
Q

Drug to close holes

A

Indomethacin (PGE2 antagonist NSAID)

Hence you don’t give pregnant women NSAIDs as they can cause premature closure

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22
Q

List the 3 Acyanotic > Obstructive conditions

A

Coarctation of Aorta
Aortic stenosis
Pulmonary stenosis

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23
Q

List the 4 Acyanotic > L to R Shunt conditions

A

Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Atrioventricular septal defect

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24
Q

Septal defects are acyanotic or cyanotic

A

Acyanotic

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25
Q

How to remember cyanotic conditions

A

5 blue TsHirts

5 T lesions from 1-5

26
Q

List 6 cyanotic conditions

A

5 Ts and an H

  1. Truncus arteriosus (1 vessel)
  2. Transposition of Great Arteries TGA (2 vessels)
  3. Tricuspid Atresia (3 valve cusps)
  4. Tetralogy of Fallot ToF (4 components)
  5. Total Anomalous Pulmonary Venous Connection TAPVC (5 words)
  6. Hypoplastic left heart syndrome (HLHS)

Others:

  • Ebstein’s anomaly
  • Pulmonary atresia
  • Interrupted Aortic Arch (IAA)
27
Q

Turner Syndrome and Bicuspid aortic valve assoc with?

A

Coarctation of aorta

28
Q

2 day old female
Suddenly shocked
Weak/absent femoral pulse
Discolouration of lower limbs compared to upper limbs
Continuous/late systolic murmur over thoracic spine

A

Coarctation of aorta
(ductus arteriosus closes at 2 days –> shock)
Murmur due to collaterals

Radio-femoral delay or difference in blood pressures, cardiomegaly in older children

29
Q

Ex findings of coarctation of aorta

A 
Signs of Turner syndrome
Shocked
Radio-femoral delay
Maybe radial-radial delay
High BP in arms, low BP in legs
Cardiomegaly
30
Q

CXR shows rib notching in posterior third of ribs 3-8

Aorta shows “Figure 3 sign”

A

Coarctation of aorta
Rib notching due to erosion by large collateral intercostal arteries
Figure 3: pre- and post-coarctation dilation

31
Q

Rx of coarctation of aorta

A

If severe, immediate prostaglandin infusion (patent ductus arteriosus)
Surgical correction of constricted part (or balloon angioplasty)

32
Q

William’s syndrome

A

Supravalvular aortic stenosis

33
Q

Older child
Ejection systolic murmur
Syncope, angina and dyspnea
Acyanotic

A

Aortic stenosis

leads to LV hypertrophy

34
Q

Rx for symptomatic aortic stenosis

A

Balloon valvuloplasty

Valve replacement later in life

35
Q

Noonan syndrome and ejection systolic murmur

Acyanotic

A

Pulmonary stenosis

leads to RV hypertrophy

36
Q

Pathophys of ASD

A

Left to Right shunt

Increased flow/volume through R heart and lungs

37
Q

Usually asymptomatic
Recurrent chest infections
Ejection systolic murmur at left upper sternal border
Wide fixed splitting of S2
Acyanotic
Dilated pulmonary artery with hilar congestion on CXR

A

ASD

increased flow across pulmonary valve, leading to delayed closure

38
Q

Risk of embolism

A

ASD

39
Q

Rx of ASD

A

If

40
Q 
4-6weeks old
Recurrent URTIs
Poor feeding
Tachypnoea
Sweating
Failure to thrive
Harsh pansystolic murmur at left lower sternal border
Radiating to axilla and across praecordium
Loud P2 
Heart failure
A

VSD
Louder in smaller defects (more turbulence)

Large VSD (aka greater than aortic valve) can lead to heart failure by 2 months old

41
Q

Pathophys of VSD

A

Left to Right shunt

Increased flow/volume through lungs and Left heart

42
Q

CXR: pulmonary plethora but otherwise normal.

In more severe cases: cardiomegaly, pulmonary oedema, pleural effusion

A

VSD

43
Q

Rx of VSD

A

Small VSDs close spontaneously, give proph ABx before surgeries, maintain good dental hygiene.

Large VSD:
Support feeds: High caloric milk via NG tube
Heart failure: Frusemide and ACEi
Surgical closure by 12-18months

44
Q

Hx of VSD

A 
4-6weeks old
recurrent URTIs
Poor feeding
Tachypnoea
Sweating
Failure to thrive
45
Q

Ex of VSD

A 
Acyanotic
FTT
Harsh pansystolic murmur at left lower sternal border, radiating to axilla or across praecordium
Loud P2
Lungs: pulm edema/crackles
Hepatomegaly
46
Q

Most common congenital heart defect overall

A

VSD

47
Q

Most common cyanotic congenital heart defect

A

ToF

48
Q

Proportion of VSD that will close spontaneously

A

3/4 (75%)

49
Q

When is ductus arteriosus defined as patent

A

Failure to close by 1 month after expected date of delivery

normally closes within first couple of days

50
Q

Congenital rubella syndrome assoc with

A

Patent Ductus Arteriosus

51
Q

Premature likely to have which acyanotic condition?

A

PDA (hasn’t had time to close yet)

52
Q 
1 month old, or premature baby
Continuous "machinery" murmur at clavicle
Bounding femoral pulse (and collapsing)
Pulmonary oedema 
Wide pulse pressure
A

Patent Ductus Arteriosus

53
Q

Rx PDA

A

Premature: indomethacin

Term infants: catheter or surgical closure

54
Q

Down Syndrome assoc with

A

Atrioventricular septal defect

55
Q

Atrioventricular septal defect involves a large defect of the

A

Atrial and ventricular septums

endocardial cushion defect

56
Q 
Trisomy 21
Dyspnea
Poor feeding
Sweating
May be cyanotic 
May have a murmur
A

AVSD

57
Q

What is Eisenmenger’s syndrome?

A

A complication of CHD
when a L>R shunt leads to pulmonary HTN (Right Ventricular hypertrophy and Pulmonary Artery hypertrophy), causing a SHUNT REVERSAL hence a R>L shunt.
Becomes cyanotic.

58
Q

How long after does Eisenmenger’s syndrome occur

A

10-15 yeras later

59
Q 
Cyanosis in a previously acyanotic patient
Clubbing
Heart failure
Death
New early diastolic murmur
A

Eisenmenger’s syndrome

Murmur from Pulmonary regurgitation

60
Q

Rx of Eisenmenger’s syndrome

A

Heart-lung transplant

61
Q

When do cyanotic lesions often present

A

After natural closure of ductus arteriosus

62
Q

Differentiating between the causes of ‘cyanosis’

A 
Anaemia
Respiratory (Hyperoxia test, give baby 100% O2 for 10 minutes, if sats do not rise then cardiovascular)
Cardiovascular (Pre-ductal O2 sats from RIGHT HAND vs Post-ductal O2 sats from a foot. If these are different, can indicate PDA is being used to maintain sats in a cyanotic R>L shunt)

PDS (2 decks)

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