Cardiology

Question 1

Fixed splitting of the second heart sound is seen in…

Answer 1

ASD

Question 2

3rd heart sound in the mitral region is seen in…

Answer 2

Normal children

Question 3

3 conditions causing left to right shunting

Answer 3

ASD, VSD, PDA

Question 4

Findings in ASD

Answer 4

ESM at the ULSE caused by increased flow across the pulmonary valve because of the left to right shunt
Fixed and widely split second heart sound due to the RV stroke volume being equal in inspiration and expiration
With partial AVSD, an apical pansystolic murmur from AV valve regurgitation

Question 5

Findings in small VSD

Answer 5

Asymptomatic
Loud pansystolic murmur at LLSE
Quiet pulmonary second sound

Question 6

Findings in large VSD

Answer 6

Active precordium
Soft pansystolic murmur (or none if large defect)
Apical mid diastolic murmur (from increased flow across the mitral valve after the blood has circulated through the lungs)
Loud pulmonary second sound

Question 7

Findings in PDA

Answer 7

Continuous murmur beneath the left clavicle

Collapsing or bounding pulse

Question 8

Conditions causing right to left shunting

Answer 8

ToF, TGA, Eisenmenger

Question 9

Features of ToF

Answer 9

Large VSD
Overriding of the aorta with respect to the ventricular septum
Subpulmonary stenosis causing RV outflow tract obstruction
RV hypertrophy as a result

Question 10

Findings in ToF

Answer 10

Clubbing of fingers and toes in older children
Loud harsh ejection systolic murmur at left sternal edge
With increased RV outflow tract obstruction, the murmur will shorten and cyanosis will increase

Question 11

Findings in TGA

Answer 11

Cyanosis ALWAYS
Second heart sound often loud and single
Usually no murmur, but there can be a systolic murmur from increased flow or stenosis within the LV outflow tract

Question 12

Findings in aortic stenosis

Answer 12

Small volume, slow rising pulses
Carotid thrill
ESM at the URSE radiating to the neck
Delayed and soft aortic second sound
Apical ejection click

Question 13

Findings in pulmonary stenosis

Answer 13

ESM at the ULSE; thrill may be present
Ejection click at the ULSE
RV heave if severe

Question 14

Findings in coarctation of the aorta

Answer 14

ESM at upper sternal edge
Collaterals heard with continuous murmur at the back
Radiofemoral delay due to blood bypassing the obstruction via collateral vessels in the chest wall, so the pulse in the legs is delayed