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1. PPS Board Prep_Mar > CARDIO > Flashcards

CARDIO Flashcards

1
Q

MC cause of pediatric heart failure in children

A

Congenital heart disease

Volume overload lesions (VSD, ASD, PDA) MC in the first 6mos of life

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2
Q

Heart failure management (6)

A

IDAPAS
1. Inotropes: to improve cardiac contractility
2. Diuretics: reduce pulmo congestion
3.ACE/ARBs: reduce afterload
4. Penicillin/Prednisone
5. Aspirin/Antibx
5. Support
> high back rest
> Appropriate fluid therapy
> O2, ventilatory support
> Nutrition

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3
Q

MC pediatric cardiac tumor

A

Rhabdomyomas
> asstd w tuberous sclerosis

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4
Q

Matching type:
A. pressure work
B. volume load
C. intrinsic myocardial function

Afterload, Preload, Contractility

A

A. pressure work: Afterload
B. volume load: Preload
C. intrinsic myocardial function: Contractility

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5
Q

Saccular aneurysms seen in what phase of Kawasaki Disease?

A

1st phase: neutrophilic necrotizing arteritis

2nd phase: subacute/chronic vasculitis - Fusiform aneurysm

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6
Q

Principle criteria of Kawasaki Disease

A

CRASH+ Burn
1. Fever 38deg, at least 5 days
2. Conjunctivitis, bilateral non exudative w limbal sparing
3. Rash - polymorphic
4. Adenopathy - unilateral cervical at least >1.5cm
5. Strawberry tongue - erythema of oral and pharyngeal mucosa, dry cracked cherry lips
6. Hands and feet - edema and erythema

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7
Q

Highest risk of sudden death is seen in which phase of Kawaski disease?

A
  1. Subacute phase
    * periungual desquamation of fingers and toes: 2-3 wks
    * thrombocytosis
    * development of CAA
    * highest risk of sudden death
    * lasts 3 weeks
  2. acute febrile phase
    * fever lasting 1-2wks
    * acute phase: perineal desquamation
  3. Convalescent phase
    * all clinical signs of illness disappeared
    * continues until ESR returns to normal
    * 6-8wks after onset of illness
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8
Q

Diagnostic criteria for RHD

A

MAJOR (JONES)
1. Polyarthritis
2. Carditis
3. Subcutaneous nodules
4. Erythema maginatum
5. Syndenham chorea

MINOR (CAFE PAL)
1. elev CRP
2. Arthralgia- must not included if arthritis is included
> monoarthralgia in mid/high risk pop
3. Fever
Mod/High risk: >38degC
Low risk: >38.5degC
4. elev ESR
- >30mm/hr in mod/high risk
- >60mm/hr in low risk
5. Prolonged PR interval
6. Grp A Strep
> culture
> rapid ag tests
> ab titers

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9
Q

Circumstances where ARF diagnosis can be made WITHOUT strict criteria adherence

A

CIR
1. Chorea is the only major manifestation
2. Indolent carditis is the only manifestation in patients who first come to medic attention ony months after the apparent onset of ARF
3. Recurrences of ARF in high risk populations

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10
Q

Minimum # criteria to fulfil RHD diagnosis?

Initial attack:
Recurrent attacks:

A

Initial attack:
Evidence of GAS inx PLUS
> 2 major
> 1 major 2 minor

Recurrent attacks:
Evidence of GAS inx PLUS
> 2 major
> 1 major 2 minor
> or 3 minor in mod/high risk population

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11
Q

TRUE or FALSE. Myocarditis and/or pericarditis without evidence of endocarditis is almost never RHD.

A

TRUE

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12
Q

A substernal thrust indicates __.

A. LVH
B. RVH
C. RAE
D. LAE

A

B. RVH

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13
Q

An apical heave indicates __.

A. LVH
B. RVH
C. RAE
D. LAE

A

A. LVH

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14
Q

Murmur grading: I-VI

A

I: barely audible
II: medium intensity
III: loud, NO thrill
IV, loud with THRILL
V. very loud
VI: loud enough w stethoscope above the chest

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15
Q

Characteristics of innocent mumurs

A

INNOCENT MURMURS- 7S
1. soft
2. short
3. single
4. sweet (musical)
5. sensitive
6. small
7. systolic

  1. medium pitched
  2. vibratory
  3. musical
  4. short systolic ejection murmur
  5. at the LL or MSB
  6. bet 3-7yo
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16
Q

MC CHD in infancy

A

VSD

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17
Q

MC CHD beyond infancy

A

TOF

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18
Q

Components of TOF

A

DROP
1. VSD: shunting L –> R
2. RVH
3. Overriding of the VSD by the aorta
4. PS

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19
Q

Murmur of TOF is caused by:
A. VSD
B. PS
C. MR
D. PR

A

Pulmonary stenosis
> caused by the turbulence in the RVOT
> less audible during tet spell because blood is shunted away from RVOT via AV

20
Q

Rib notching is appreciated in what CHD

A. VSD
B. TGA
C. TAPVR
D. COA

A

COA

21
Q

Complications of uncorrected TOF (3)

A

Cerebral thromboses
Brain abscess
Bacterial endocarditis

22
Q

Pathophy of tet spells

A

Pag agitated, crying, dehydrated, fever, exercise or play, there is an increase in pulmo vascular resistance. Therefore, walang BF sa already stenotic na Pulmo valve – kaya nawawala yung murmur ng PS

Squatting:
kinks the BV of the LE to increase systemic vascular resistance to decrease shunting of blood from right to left, therefore increasing BF to the pulmonary artery.

23
Q

The primary developmental defect in tetralogy of Fallot that is responsible for the characteristic 4 cardiac defects is what?

A. Anomaly in arch development
B. Anterior displacement of the infundibular septum
C. Downward displacement of the tricuspid valve
D. Downward displacement of the tricuspid valve

A

B. Anterior displacement of the infundibular septum

> Tetralogy of Fallot is one of the conotruncal family of heart lesions in which the primary defect is an anterior deviation of the infundibular septum (the muscular septum that separates the aortic and pulmonary outflows)

24
Q

Which cardiac defect has the worst prognosis, without immediate surgical correction?

A. d-TGA with no associated defects
B. l-TGA with no associated defects
C. d-TGA with large ASD
D. d-TGA with restrictive VSD
E. l-TGA with restrictive VSD

A

A. d-TGA with no associated defects

d-Transposition of the great arteries is a medical emergency. Cyanosis and tachypnea are most often recognized within the 1st hours or days of life. If it is not treated, the vast majority of these infants would not survive the neonatal period. Hypoxemia is usually moderate to severe, depending on the degree of atrial level shunting and whether the ductus is partially open or totally closed. Infants who remain severely hypoxic or acidotic despite prostaglandin infusion should undergo Rashkind balloon atrial septostomy. A successful Rashkind atrial septostomy should result in a rise in PaO2 to 35-50 mm Hg and elimination of any pressure gradient across the atrial septum. Some patients with TGA and VSD may require balloon atrial septostomy because of poor mixing, even though the VSD is large. If the VSD associated with d-TGA is small, the clinical manifestations, laboratory findings, and treatment are similar to those described previously for transposition with an intact ventricular septum. When the VSD is large and not restrictive to ventricular ejection, significant mixing of oxygenated and deoxygenated blood usually occurs and clinical manifestations of cardiac failure are seen. The degree of cyanosis may be subtle and sometimes may not be recognized until an oxygen saturation measurement is performed. The physiology of l-TGA is quite different from that of d-TGA. The double inversion of the atrioventricular and ventriculoarterial relationships result in desaturated right atrial blood appropriately flowing to the lungs and oxygenated pulmonary venous blood appropriately flowing to the aorta. The circulation is thus physiologically “corrected.” Without other defects, the hemodynamics would be nearly normal.

25
Q

Criteria for infective endocarditis

A

Two major criteria, 1 major and 3 minor, or 5 minor criteria suggest definite endocarditis.

Major criteria
(1) positive blood cultures (2 separate cultures for a usual pathogen, 2 or more for less typical pathogens)
(2) evidence of endocarditis on echocardiography (intracardiac mass on a valve or other site, regurgitant flow near a prosthesis, abscess, partial dehiscence of prosthetic valves, or new valve regurgitant flow).

Minor criteria:
> fever
> embolic-vascular signs
> immune complex phenomena (glomerulonephritis, arthritis, rheumatoid factor, Osler nodes, Roth spots)
> a single positive blood culture or serologic evidence of infection
> echocardiographic signs not meeting the major criteria.

A modification of the Duke criteria may increase sensitivity while maintaining specificity. The following minor criteria are added to those already listed
> the presence of newly diagnosed clubbing, splenomegaly, splinter hemorrhages, and petechiae
> a high erythrocyte sedimentation rate
> a high C-reactive protein level
> the presence of central nonfeeding lines, peripheral lines, and microscopic hematuria

26
Q

MC cause of Pulmonary HTN in children

A

Congenital heart disease (40-55%)

27
Q

MC mechanism of SVT in infants

A. Atrioventricular reciprocating tachycardia (AVRT)
B. Atrioventricular node reentry tachycardia (AVNT)
C. Ectopic/autonomic tachycardias

A

A. Atrioventricular reciprocating tachycardia (AVRT)
> reetrant tachycardia with accessory pathway

28
Q

MC cause of death in the athletic adolescent

A. Dilated CM
B. Hypertrophic CM
C. Restrictive CM

A

B. Hypertrophic CM

29
Q

Leading causative agent for bacterial endocarditis

A. Viridans strep
B. Group A hemolytic strep
C. Staph aureus
D. A and B
E. All

A

All

> Staph endocarditis more often seen in patients w no underlying heart dse
Viridans strep: after dental procedures
Group D enterococci after lower bowel or geitourinary manipulation
Pseudomonas aeruginosa and Serratia marcesens: IV drug users
Fungal: after open heart surgery
CONS: indwelling central venous catheter

30
Q

Etiologic agent causing infective endocarditis in after dental sugery

A

Viridans strep

31
Q

Etiologic agent causing infective endocarditis in after lower bowel or genitourinary surgery

A

Grp D enterococci

32
Q

Etiologic agent causing infective endocarditis in patients w no underlying heart disease

A

Staphylococcus

33
Q

Etiologic agent causing infective endocarditis in IV drug users

A

P. aeruginosa
S. marcesens

34
Q

Etiologic agent causing infective endocarditis in after open heart surgery

A

Fungi

35
Q

Many of the classic skin findings in IE develop _ in the disease

Early
Late

A

Late

36
Q

Tender, pea-sized intradermal nodules in the pads of the fingers and toes

A

Osler
O- peas
O-ouch - painful

37
Q

Painless, small erythematous or hemorrhagic lesions on the palms and soles

A

Janeway lesions

38
Q

Janeway lesions and Osler nodes are seen what disease entity?

A

Bacterial endocarditis

39
Q

Modified Duke Criteria

A

BE TIMER
MAJOR
1. Bacterial culture
2. Evidence of endocardial involvement: echo

MINOR
1. Temp: Fever >38degC
2. Immunologic phenomena: Osler nodes, Roth spots, GN
3. Microbiologic evidence: culture positive not fulfilling major criteria
4. Emboli phenomena, vascular phenomena
5. Risk factors: CHD, prosthetic device, IV drug users

40
Q

Minimum criteria for Definitive endocarditis

A

2 major
1 major, 3 minor
5 minor

41
Q

Minimum criteria for Possible endocarditis

A

1 major 1 minor
3 minor

42
Q

Treatment of choice for restrictive CM

A

Cardiac transplant

Pharma management are of limited use

43
Q

MC symptom of acute pericarditis

A

chest pain

> sharp/stabbing positional, worse with inspiration, relieved by sitting upright or prone.

44
Q

Definition of HTN for children (AAP 2017)

A

NORMAL: <90p for age, sex, ht or
< 120/80 for adol

Elevated: 90 - <95p for age, sex, ht or
120-129 / <80 for adol

Stage 1 HTN: >95p for age sex and ht up to 95p +11mmHg or 130-139 / 80-89 for adol

Stage 2 HTN: >95p +12mmHg for age sex and ht or >140/90 for adol

45
Q

BP measurement is recommended to be included in every consult starting at age _

A

3yo

46
Q

Small BP cuff size will result in _ results
Large BP cuff sizes will result in _ results

BP cuff length should cover _ of upper arm circumference and width _ of the arm circumference

A

High
Low

80-100%
40%

47
Q

Closure of PDA

Functional
Physiologic

A

Functional: 14 hrs
Physiologic: 14 weeks

1. PPS Board Prep_Mar (16 decks)

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