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A. PEDIA BOARD REVIEW > CARDIO Chap 420-445 > Flashcards

CARDIO Chap 420-445 Flashcards

1
Q

Mature equivalent of

Bulbus cordis

A

Right ventricle

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2
Q

Mature equivalent of

Truncus arteriosus

A

Aorta & pulmonary artery

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3
Q

Mature equivalent of

Sinus venosus

A

Atria

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4
Q

Radial-Femoral delay (radial pulse felt prior to femoral pulse)

A

Coarctation of the aorta

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5
Q

Mid systolic click

A

Mitral valve prolapse

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6
Q

Pulmonary ejection clicks

A

Pulmonary stenosis

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7
Q

ECG: Positive T wave in V4R and V1, Tall R wave and deep S wave in V6 in an infant

A

RVH

*Normal infants has inverted T waves in V4R, V1 and V3R until 2 years

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8
Q

Tall (>2.5mm), narrow, spiked P waves

A

Right Atrial enlargement (PS, Ebstein anomaly, Tricuspid Atresia)

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9
Q

Broad, bifid, biphasic P waves

A

Left Atrial enlargement (large left to right shunts)

*Remember B

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10
Q

Flat P wave

A

Hyperkalemia

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11
Q

Mutation in dystrophin gene (chromosome Xp21)

A

Dilated Cardiomyopathy

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12
Q

MC form of ASD

A

Ostium secundum defect

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13
Q

7yo, Patient came in due to exercise intolerance
No symptoms prior

Pe: left precordial bulge, palpable right ventricular systolic lift at left sternal border, noted FIXED WIDELY SPLIT 2ND heart sound in ALL PHASES of respiration, and SYSTOLIC EJECTION murmur heard at left middle and upper sternal border

CXR: Enlarged pulmonary artery, increased pulmonary vascularity

A

Atrial Septal defect

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14
Q

Scimitar syndrome

- cresenteric shadow of vascular density along the right border of cardiac silhouette seen in CXR

A

Partial Anomalous Pulmonary Venous Return (PAPVR)

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15
Q

Down syndrome with wide fixed splitting of S2 and apical holosystolic murmur that radiates to the left axilla

A

Atrioventricular Septal defect

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16
Q

MC cardiac malformation

A

VSD

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17
Q

MC type of VSD

A

Membranous type

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18
Q

VSD associated with Aortic Regurgitation

More common in Asian & males

A

Supracristal VSD

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19
Q

Continuous systolic machinery-like murmur best heard at the 2nd left intercostal space that radiates to the left clavicle

A

Patent Ductus Arteriosus (PDA)

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20
Q

Pulmonary stenosis secondary to valve dysplasia

MC cardiac anomaly in?

A

Noonan syndrome

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21
Q

MC right ventricular outflow obstruction

A

Isolated Pulmonary Stenosis

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22
Q

Initial treatment of choice for pulmonary stenosis

A

Balloon Valvuloplasty

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23
Q

T/F: Clinical manifestations of Acyanotic heart disease with obstructive lesions (VALVULAR STENOSIS) depends on the degree of obstruction

A

True

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24
Q

Endocardial fibroelastosis (endocardial fibrous scarring associated with which type of obstructive heart lesion)

A

Aortic Stenosis

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25
Q

Risk of sudden death during or immediately after exercise if unoperated

A

Severe Aortic Stenosis

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26
Q

MC origin of coarctation of the aorta

A

Juxtaductal coarctation (below the origin of the left subclavian artery at the origin of the ductus)

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27
Q

Hypertension in upper extremities but low blood pressure in lower extremities
Bounding pulses on the upper extremities with weak pulse lower extremities

CXR: notching of inferior border of the ribs

A

Coarctation of the aorta

*notching of inferior border of the ribs - due to pressure of collateral vessels

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28
Q

SHONE complex

A

Mitral stenosis
Subvalvar Aortic Stenosis
Coarctation of the aorta

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29
Q

High-pitched, apical holosystolic murmur

CXR: Left atrial and ventricular enlargement
ECG: Bifid p waves

A

Mitral insufficiency

*Bifid p waves (LA enlargement)

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30
Q

Late systolic apical murmur preceded by a click

Associated with Marfan syndrome & Ehler-Danlos syndrome

A

Mitral valve prolapse

-billowing of one or both mitral leaflets especially posterior cusp at the end of systole

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31
Q

Test to distinguish cyanotic congenital heart disease from pulmonary disease

A

Hyperoxia test

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32
Q

Cyanotic congenital heart disease with primary defect is an anterior deviation of the infundibular septum

A

Tetralogy of Fallot (TOF)

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33
Q

Complete obstruction of the right outflow tract

A

Pulmonary atresia

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34
Q

Cyanotic child, hyperpneic and restless, gasping

Pe: dusky skin, clubbing of fingers, with left anterior hemithorax bulge

Diagnosis?
Management?

A

Paroxysmal hypercyanotic attack (Tet spell) in TOF

Knee to chest position
Morphine (0.2mg/kg)
Propanolol (0.1mg/kg)
If severe, correct acidosis with Sodium bicarbonate

*loud systolic murmur of TOF usually disappears in Tet spells

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35
Q

Boot shaped heart in CXR (coeur en sabot)

A

Tetralogy of Fallot

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36
Q

TOF is commonly associated with what syndrome

A

Di George Syndrome (CATCH 22)

Cardiac anomalies
Abnormal facies
Thymic hypoplasia
Cleft palate
Hypocalcemia
Deletion in chomosome 22q11.2
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37
Q

Medication to maintain patency of ductus arteriosus especially in ductal dependent heart disease

A

Prostaglandin E1 (0.01-0.2umg/kg/min)

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38
Q

Medication ised to decrease frequency and severity of hypercyanotic spells

A

Oral Propanolol (0.5-1mg/kg every 6 hours)

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39
Q

Palliative systemic-to-pulmonary artery shunt in TOF

A

Blalock-Taussig shunt

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40
Q

Cyanosis with left axis deviation and LVH in ECG

A

Tricuspid Atresia

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41
Q

Downward displacementnof an abnormal tricuspid valve into the right ventricle

A

Ebstein Anomaly

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42
Q

CXR: Boxed shaped heart

A

Ebstein anomaly

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43
Q

CXR: Egg on a string

A

Transposition of Great Arteries (TGA)

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44
Q

Neonate presents with dyspnea & cyanosis in the first hour of life. Unresponsive to hyperoxia test. O2 sat is 75%

(+) Maternal DM

CXR: Egg on a string

A

Transposition of Great Arteries

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45
Q

Treatment of choice for d-TGA

A

Arterial switch (Jatene) procedure

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46
Q

T/F: Obstructive TAPVR is a pediatric cardiac emergrny

A

True. Because prostaglandin is ineffective

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47
Q

T/F: Obstructive TAPVR is a pediatric cardiac emergrny

A

True. Because prostaglandin is ineffective

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48
Q

CXR: Snowman sign or Figure of 8

*perihilar pattern of pulmonary edema

A

Total Anomalous Pulmonary Venous Return

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49
Q

Single arterial trunk arises from the heart

VSD always present

A

Truncus Arteriosus

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50
Q

Pulmonary vascular obstructive disease and right-sided heart failure

A

Pulmonary Hypertension

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51
Q

MC cause of Pulmonary Hypertension

A

Idiopathic or Familial

52
Q

Development of pulmonary vascular disease in congenital heart disease due to unrestricted pulmonary blood flow

A

Eisenmenger Syndrome

53
Q

Development of pulmonary vascular disease in congenital heart disease due to unrestricted pulmonary blood flow that is minimally responsive to pulmonary vasodilators

A

Eisenmenger Syndrome (obstructive pathologic changes in the pulmonary vessels)

54
Q

Factors that increase the risk of developing Eisenmenger syndrome

A

Increased pulmonary arterial pressure
Increased pulmonary blood flow
Hypoxia or hypercapnia

55
Q

Normal physiologic variation if rhythm related to respiration

A

Phasic sinus arrythmia

56
Q

Intermittent shift in the pacemaker of the heart from sinus node to another part of the atrium

A

Wandering atrial pacemaker

*normal variant

57
Q

Premature P wave preceding QRS

Reset sinus node pacemaker leading to incomplete compensatory pause

A

Premature Atrial Contractions (PAC)

58
Q

Premature, widened, bizarre QRS complexes not preceded by a premature P wave

A

Premature Ventricular Contraction (PVC)

59
Q

First line of therapy for PVC

A

Lidocaine (1mg/kg q5mins x2 doses, then 20-50ug/k/min drip)

60
Q

Treatment for refractory PVC

A

Amiodarone

61
Q

Narrow QRS complex
>230 beats/min in neonates
Abnormal P wave axis

A

Supraventricular Tachycardia (SVT)

62
Q

Short P-R interval

Slow upstroke of QRS (Delta wave)

A

Wolf-Parkinson-White Syndrome

63
Q

Treatment of choice for stable patients with SVT

A

Adenosine (rapid IV push)

64
Q

Treatment of SVT with symptoms of heart failure

A

Synchronized cardioversion (0.5-2J/kg)

65
Q

Maintenance therapy for SVT with antegrade accessory pathway (non-WPW)

A

Beta-Blockers

66
Q

Arrythmia most often recognized in early postoperative period after cardiac surgery

It is an automatic arrythmia in which junctional rate exceeds that of the sinus node

Tx?

A

Accelerated Junctional Ectopic Tachycardia

Tx: Amiodarone

67
Q

ECG: Saw tooth waves

Dx & Tx?

A

Atrial flutter

Tx: Synchronized Cardioversion

68
Q

Irregularly irregular rhythm, absent p waves, irregular R-R interval

A

Atrial fibrillation

69
Q

Treatment of choice in hemodynamically UNSTABLE patients with Atrial flutter and Ventricular tachycardia

A

Cardioversion

70
Q

Presence of at least 3 PVCs at >120 beats/min

A

Ventricular tachycardia

71
Q

Treatment of choice during cardiac arrest with ventricular tachycardia

A

Amiodarone (2.5-5mg/kg over 30 to 60mins)

72
Q

Long QT syndrome associated with congenital sensorineural deafness

A

Jervell-Lange-Nielsen syndrome

73
Q

Long QT syndrome associated during sleep

A

LQT3

Highly lethal

74
Q

Sudden pause in heat beat due to failure of impulse formation within thesinus node

A

Sinus arrest

75
Q

Sudden pause in heat beat due to a block between the sinus pacemaker complex and the surrounding atrium

A

Sinoatrial block

76
Q

ECG: Prolonged PR interval but all atrial impulses conducted to ventricles

A

1st degree AV block

77
Q

ECG: PR interval increases progressively then drop beat (P wave not conducted), afterwards normal rhythm

A

2nd degree AV block (Mobitz Type 1, Wenckebach type)

78
Q

ECG: Normal PR interval the drop beat

A

2nd degree AV block (Mobitz Type II)

79
Q

ECG: multiple P waves but rare QRS (escape rhythm)

No impulse from the atria reach the ventricles

A

3rd degree AV block (complete heart block)

80
Q

ECG: P wave and QRS have no constant relationship

Mother has autoimmune disease (SLE, Sjogren)

A

Congenital complete AV block

81
Q

MC cause of death in competitive athletes

A

Hypertrophic Heart Disease

82
Q

Coronary artery anomaly associated with sudden death

A

Origin of the LEFT coronary artert from the Right sinus of Valsalva (traverses the aorta and pulmonary artery, during exercise, increase aortic & pulmonary pressure leading to compression of left coronary artery resulting to ischemoa)

83
Q

Pathology: transmural fatty replacement of right ventricular myocardium with patchy areas of fibrosis

Associated with sudden death

A

Arrythmogenic right ventricular dysplasia

84
Q

T/F: Digoxin & Verapamil are contraindicated in Wolf-Parkinson-White (WPW) Syndrome

A

True (because they can augment conduction down accessory pathways)

85
Q

Corrected QTc interval of >0.47sec

A

Long QT syndrome

86
Q

Mechanism of sudden death in long QT syndrome

A

Torsades de pointes (polymorphic ventricular tachycardia)

87
Q

ECG: coved ST segment elevation in V1-V3

Autosomal dominant
Mutation in SCN5A gene
Associated with fever, nighttime electrolyte disorders, or occur after a large meal

A

Brugada syndrome

88
Q

Universally fatal condition following blunt nonpenetrating trauma

Associated with ventricular fibrillation unresponsive to resuscitative efforts

A

Commotio cordis

89
Q

Therapy of choice for survivors of arrythmic sudden death

A

Implantable cardioverter defibrillator

90
Q

Leading cause of endocarditis in pediatric patients

A

Group A Hemolytic Streptococcus & Staphylococcus aureus

91
Q

Tender, pea sized intrademal nodules in the pads of fingers & toes in Infective Endocarditis

A

Osler nodes

92
Q

Painless, small erythematous hemorrhagic lesions on yhe plam & soles in Infective Endocarditis

A

Janeway lesions

93
Q

Linear lesions beneath the nails in in Infective Endocarditis

A

Splinter hemorrhages

94
Q

MC organism causing Infective Endocarditis in intravenous drug users

A

Pseudomonas aeruginosa

Serratia marcenses

95
Q

MC organism causing Infective Endocarditis in patients with indwelling catheters

A

Coagulase negative Staphylococci

96
Q

T/F: absence of vegetations DOES NOT EXCLUDE Endocarditis

A

True (some vegetations are often not visualized in the early phase of disease)

97
Q

Duke Major criterias for Infective Endocarditis

A

Positive blood cultures (2 separate cultures)

Evidence of Endocarditis in 2d echo

98
Q

Duke Minor criterias for Infective Endocarditis

A

Predisposing conditions
Fever
Embolic vascular signs
Immune complex phenomena (GN, arthritis, osler nodes, roth spoths)
Presence of newly diagnosed clubbing, splenomegaly, splinter hemorrhages, & petechiae
High ESR
High CRP
Presence of indwelling lines
Microscopic hematuria
Single, positive blood culture
Echocardiographic signs not meeting criteria

99
Q

Empirical therapy for IE patients without prosthetic valve at high risk for S. Aureus, enterococcus or Strep viridians

A

Vancomycin (40mkday in 2-3 doses) plus

Gentamicin (3mkday in 3 doses) for 4 to 6 weeks

100
Q

T/F: Surgery is indicated for patient with IE with SEVERE aortic, mitral or prosthetic involvement with INTRACTABLE heart failure

101
Q

MC affected valve in Acute Rheumatic Fever

A

Mitral valve

102
Q

Previous history of Rheumatic fever
With holosystolic murmur best heard at apex radiating to the axilla

ECG: bifid P waves, LVH
2D echo: thickened mitral valve

A

Rheumatic Heart Disease (Mitral Insufficiency)

103
Q

Prophylaxis for bacterial endocarditis

A

Oral Amoxicillin 50mkdose

Oral Cephalexin, Clarithromycin, Azithromycin or Clindamycin (if penicillin allergic)

104
Q

Wide pulse pressure with bounding peripheral pulses
Left ventricular apical heave
High pitched, blowing murmur beginning at the 2nd heart sound up to late diastole heard best at the upper and midleft sternal border radiating to the apex and upper right sternal border

A

Aortic insufficiency

105
Q

MC form of Cardiomyopathy

Common indication for cardiac transplanntation

A

Dilated Cardiomyopathy

106
Q

Increased left ventricular wall thickness in the absence of structural heart disease

A

Hypertrophic Cardiomyopathy

107
Q

Normal ventricular chamber dimensions and myocardial wall thickness, preserved systolic function but with diastolic dysfunction

2D echo: markedly dilated atria

A

Restrictive Cardiomyopathy

Tx of choice: Cardiac Transplantation

108
Q

Distinctive trabeculated or spongy-appearing left ventricle

A

Left ventricular noncompaction

109
Q

Stroke vokume x Heart rate

A

Cardiac output

110
Q

Most commonly used parameter in assessing ventricular fubctionnin 2d echo

A

Fractional shortening (difference between End systolic and end diastolic diameter divided by end-diastolic diameter)

Normal: 28-42%

111
Q

MC used diuretic in pediatric heart failure

A

Furosemide

112
Q

May present with THIOCYANATE POISONING (fatigue, nausea, disorientation, acidosis, muscular spasm) when given in high doses for several days

A

Nitroprusside (peripheral arterial vasodilation & after load reduction)

113
Q

T/F: Hypokalemia, hypomagnesemia, and hypercalcemia potentiates digitalis toxicity

114
Q

Given innpatients with low cardiac oitput refractory to standard therapy

A

Milrinone (phosphodiesterase inhibitor)

115
Q

Low cardiac output and hypotension leading to inadequate tissue perfusion

A

Cardiogenic shock

116
Q

SBP and/or DBP >/=95th percentile

A

Hypertension

117
Q

SBP and/or DBP >/=90th but <95th percentile

A

Prehypertension

118
Q

SBP and/or DBP >/=95th percentile in medical setting but normal BP outside

A

White coat hypertension

119
Q

Cause of heart failure associated with MUMPS virus

A

Endocardial fibroelastosis

120
Q

Sharp, stabbing chest pain, worse with insporation, relieved by sitting upright

Pe: perocardial friction rub, tachycardia, narrow pulse pressure, muffled or distant heart sounds, (+) jugular venous distention

A

Acute Pericarditis

121
Q

Fall of systolic BP >10mmHg with inspiration associated with sharp stabbing chest pain, muffled heart sounds, jugular venous distention

2d echo: compression and collapse of right atrium

A

Cardiac tamponade

122
Q

CXR: Erlenmeyer flask or Watter bottle appearance

A

Pericarditis

123
Q

7th day Post cardiac surgery patient presented with fever, irritability, lethargy, anorexia, chest discomfort

Dx & Tx?

A

Postpericardiotomy syndrome
-appears usually 7-14 days post op

Tx: aspirin and NSAIDs

124
Q

Pericardial scarring leading to impaired distensibility and filling

Pe: jugular venous distention, peripheral edema, hepatomegaly, ascites, distant heart sounds

Labs: abnormal liver function tests, hypoalbuminemia, hypoproteinemia, lymphopenia

A

Constrictive pericarditis

Tx: anti-inflammatory agents, pericardiectomy

125
Q

MC pediatric cardiac tumor

A

Rhabdomyoma

Associate dwith Tuberous sclerosis
Multiple lesions arising from the myocardium extending into cardiac chambers

126
Q

Second most common pediatric cardiac tumor
Solitary, intramyocardial
May cause heart failire, cyanosis or rhythm disturbances

127
Q

MC causes of secondary (metastasis) tumors in the heart

A

Wilm’s

Lymphoma/Leukemia

A. PEDIA BOARD REVIEW (13 decks)

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