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Paediatrics and Child Health > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is Still’s Murmur?

A

an INNOCENT “vibratory” murmur

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2
Q

In what ages would Still’s murmur normally present?

A

2-8 years

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3
Q

Describe Still’s Murmur

A
  1. Mid-systolic
  2. Low-medium frequency
  3. Located at the Lower Left Sternal Border near Apex
  4. Louder when Supine, Fever, Anaemia
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4
Q

What are the features of a Flow Murmur

A

The Ss:

  1. Short
  2. Soft
  3. Systolic
  4. Situation- Dependent
  5. Symptomless
  6. At Left Sternal Edge
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5
Q

What does a Brief Resolved Unexplained Event (BRUE) involve?

A

At least 1 or more of:

  1. Cyanosis or Pallor
  2. Absent, decreased or irregular breathing
  3. Change in tone
  4. Altered level of consiousness

w/ Normal HX and Examination

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6
Q

What do you need to monitor if someone presents with a BRUE?

A
  1. Vital signs
  2. ECG
  3. Pernasal Swab for Pertussis
  4. Continuous Pulse Oximetry
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7
Q

What are the risk factors for an underlying disorder in patients presenting with BRUE?

A
  1. Age <60 days or Gestation <32 weeks
  2. Duration of event > 1 min
  3. repeat event
  4. CPR given
  5. Concerning features on Hx
  6. Abnormal physical examination
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8
Q

When does Sudden Infant Death Syndrome typically occur?

A

2-4 months

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9
Q

What are the infant risk factors for SIDS?

A
  1. Age 1-6 months
  2. Low birthweight
  3. Preterm birth
  4. Male gender
  5. Appearing ill in the last 24 hours
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10
Q

What are the parental risk factors for SIDS?

A
  1. low income
  2. No maternal education qualifications
  3. Poor/ overcrowded housing
  4. Maternal age <21
  5. High maternal parity
  6. Maternal smoking during pregnancy
  7. Parental smoking after birth
  8. Maternal drug and alcohol consumption
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11
Q

What are the environmental risk factors for SIDS?

A
  1. Infant sleeping prone
  2. Overheating of infant
  3. Co-sleeping
  4. infant pillow use
  5. Infant swaddling
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12
Q

For SIDS prevention, what are advice to give to parents?

A
  1. Have infant sleep on their back
  2. Avoid overheating
  3. place infant in ‘feet to foot’ position in cot
  4. No smoking near infant
  5. Seek medical advice promptly if infant is unwell
  6. Have baby in the same bedroom for first 6 months
  7. Avoid bringing baby to bed if tired/ consumed alcohol, drugs
  8. Avoid sleeping with baby on sofa/ armchair
  9. breastfeed if possible
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13
Q

What are the congenital septal defects seen in children?

A
  1. Atrial Septal Defect
  2. Ventricular Septal Defect
  3. Patent Ductus Arteriosus
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14
Q

What are the types of Atrial Septal Defects?

A
  1. Secundum Atrial Defect–> defect in centre of atrial septum involving the foramen ovale
  2. Partial Atrioventricular Defect
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15
Q

How does Atrial Septal Defects present clinically?

A

Usually asymptomatic but can have arrhythmias pr reccurrent chest infections. Also will have Murmur

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16
Q

Describe the murmur heard in Atrial Septal Defects

A
  1. Ejection Systolic
  2. Upper Left Sternal Edge
  3. Fixed & Widely Split Second Heart Sound

In Partial AVSD–> can be apical pansystolic

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17
Q

How would you investigate Atrial Septal Defects?

A
  1. Chest X-Ray
  2. ECG
  3. Echocardiogram
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18
Q

What will you find on Chest X-ray in a patient with an Atrial Septal Defect?

A
  1. Cardiomegaly
  2. Enlarged Pulmonary Arteries
  3. Increased Vascular Markings
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19
Q

What will you find on ECG in a patient with an Atrial Septal Defect?

A

Secundum ASD:

  1. Right bundle branch block
  2. Right axis deviation

Partial AVSD:
- Superior QRS axis

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20
Q

How would you manage a patient with an Atrial Septal Defect?

A

Secundum ASD–> Cardiac Catheterisation @ 3-5 y/o

Partial AVSD–> Surgical correction @ 3 y/o

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21
Q

What syndromes are Ventricular Septal Defects associated with?

A
  1. Downs Syndrome

2. Turner Syndrome

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22
Q

How do small ventricular septal defects present?

A

Asymptomatic with Loud Pansystolic murmur at left lower sternal edge

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23
Q

How do large ventricular septal defects present?

A
  1. Heart failure
  2. Faltering growth
  3. Tachypnoea
  4. Dyspnoea
  5. Tachycardia
  6. Hepatomegaly
  7. SOFT pansystolic murmur at left lower sternal edge
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24
Q

What would you find on Chest X-Ray in a patient with a Large VSD?

A
  1. Cardiomegaly
  2. Enlarged pulmonary arteries
  3. Increased pulmonary vascular markings
  4. Pulmonary oedema
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25
Q

What would you find on ECG in a patient with a Large VSD?

A

Biventricular hypertrophy (by 2 months old)

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26
Q

How would you manage a patient with a Ventricular Septal Defect?

A
  1. Manage Heart Failure w/ Diuretics, Captopril

2. Antibiotic prophylaxis for Infective Endocarditis

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27
Q

What is the most common congenital heart disease?

A

Ventricular Septal Defect

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28
Q

How would a patient with a Patent Ductus Arteriosus present?

A
  1. Shortness of Breath
  2. Difficulty feeding
  3. Poor weight gain
  4. Lower Respiratory Tract Infections
  5. Continuous Murmur at Upper Left Sternal Edge
  6. Collapsing and Bounding pulses
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29
Q

How would you investigate a patient with a suspected Patent Ductus Arteriosus?

A

Echocardiogram

30
Q

How would you manage a patient with a patent ductus arteriosus?

A

Transcatheter Ligation or Surgical closure at 1 y/o

31
Q

What are the Acyanotic Congenital Cardiac Diseases?

A
  1. Atrial Septal Defect
  2. Ventricular Septal Defect
  3. Patent Ductus Arteriosus
  4. Coarctation of Aorta
32
Q

How would a patient with Aortic Stenosis present?

A
  1. Asymptomatic Murmur–> Ejection Systolic Murmur at Upper Right Sternal Edge radiating to neck
  2. Delayed and Soft aortic second sound
  3. Apical Ejection click
  4. Carotid thrill
  5. Small volume, slow rising pulses
33
Q

How would you investigate a patient with suspected Aortic Stenosis?

A

GOLD STANDARD: ECHOCARDIOGRAM
Chest X-Ray
ECG

34
Q

What would you find on Chest X-Ray in a patient with Aortic Stenosis?

A
  1. Prominent Left Ventricle

2. Poststenotic dilatation of ascending aorta

35
Q

What would you find on ECG in a patient with Aortic Stenosis?

A

Left Ventricular Hypertrophy–> Deep S wave in V2, Tall R wave in V6, Downgoing T wave in V6

36
Q

How would you manage a patient with Aortic Stenosis?

A
  1. Percutaneous balloon aortic valvuloplasty
  2. Surgical aortic valvotomy
  3. Valve replacement
37
Q

What is Pulmonary Stenosis associated with?

A
  1. Tetralogy of Fallot
  2. William Syndrome
  3. Noonan Syndrome
  4. Congenital Rubella Syndrome
38
Q

How do patients with Pulmonary Stenosis present?

A
  1. Asymptomatic Murmur–> Ejection systolic at Upper Left Sternal Edge
  2. Ejection click at Upper Left Sternal Edge
  3. Right Ventricular Heave
  4. Increased JVP with Giant A Waves
39
Q

How would you investigate a patient with Pulmonary Stenosis?

A

GOLD STANDARD–> ECHOCARDIOGRAM
ECG
Chest X-Ray (normal)

40
Q

What would you find on ECG in a patient with Pulmonary Stenosis?

A

Right Ventricular Hypertrophy–> Upright T Wave in V1

41
Q

How would you manage a patient with Pulmonary Stenosis?

A
  1. Balloon valvuloplasty via venous catheter

2. Open Heart Surgery

42
Q

How would a patient with Coaractation of Aorta Present?

A
  1. Weak/absent femoral pulses
  2. Tachypnoea
  3. Poor feeding
  4. Grey & floppy baby
  5. Underdeveloped legs, left arm
  6. Metabolic acidoses
  7. Left Ventricular heave
43
Q

What kind of murmur will be heard in a patient with Coarctation of Aorta?

A

Ejection Systolic murmur at Upper Left Sternal Edge

Collaterals can be heard w/ continuous murmur at the back

44
Q

How would you investigate a patient with suspected coarctation of aorta?

A
  1. 4-limb blood pressure
  2. Chest X-Ray
  3. Echocardiogram
45
Q

What genetic abnormality is Coarctation of Aorta associated with?

A

Turners Syndrome

46
Q

How would you manage a patient with Coarctation of Aorta?

A
  1. Surgical Repair

2. Insertion of Stent at Cardiac Catheter

47
Q

What are the Cyanotic Congenital Heart Disorders?

A
  1. Tetralogy of Fallot
  2. Transposition of the Great Arteries
  3. Eisenmenger Syndrome
48
Q

What does Tetralogy of Fallot consist of?

A
  1. Ventricular Septal Defect
  2. Overriding Aorta
  3. Pulmonary Valve Stenosis
  4. Right Ventricular Hypertrophy
49
Q

How would a patient with Tetralogy of Fallot present?

A
  1. Cyanosis
  2. Clubbing of fingers and toes
  3. Murmur–> Loud Harsh Ejection Systolic Murmur at Left Sternal Edge
  4. Hypercyanotic Spells
50
Q

What is a Hypercyanotic Spell?

A

Rapid increase in cyanosis, usually associated with irritability or inconsolable crying because of severe hypoxia and breathlessness and pallor because of tissue acidosis

51
Q

What is Tetralogy of Fallot Associated with?

A
  1. Rubella infection
  2. Increased Maternal Age (>40)
  3. Alcohol consumption in pregnancy
  4. Diabetic mother
52
Q

How would you investigate a patient with suspected Tetralogy of Fallot?

A
  1. Chest X-Ray
  2. ECG
  3. Echocardiogram
53
Q

What would you see on chest x-ray in a patient with Tetralogy of Fallot?

A

Small “boot-shaped” heart

Right ventricular thickening

54
Q

How would you manage a patient with Tetralogy of Fallot?

A
  1. Manage Hypercyanotic Spells

2. Total surgical repair–> Open heart surgery

55
Q

How would you manage the Hypercyanotic spells in a patient with Tetralogy of Fallot?

A
  1. Sedation and Pain Relief
  2. IV Propranolol
  3. IV Fluids
  4. Bicarbonate–> correct acidosis
  5. Artificial ventilation
56
Q

How would a patient with Transposition of Great Arteries present?

A
  1. Cyanosis
  2. No murmur
  3. Loud second heart sound
57
Q

What conditions is Transposition of Great Arteries associated with?

A
  1. Ventricular Septal Defect
  2. Coarctation of Aorta
  3. Pulmonary Stenosis
58
Q

How would you investigate a patient with suspected Transposition of Great Arteries?

A

Chest X-Ray
ECG
Echocardiogram

59
Q

What would you see on Chest X-Ray in a patient with Transposition of Great Arteries?

A

Narrow pedicle “egg on side” cardiac contour

Increased pulmonary vascular markings

60
Q

How would you manage a patient with Transposition of Great Arteries?

A
  1. Prostaglandin Infusion–> keep PDA open
  2. Balloom Atrial Septostomy
  3. Arterial Switch Operation in neonatal period
61
Q

What is Eisenmenger Syndrome?

A

An Underlying lesion allowing a left-to-right shunt causes pulmonary hypertension which then results in a reverse into a right-to-left shunt bypassing the lungs and causing cyanosis

62
Q

What are the underlying lesions that cause Eisenmenger Syndrome?

A
  1. Atrial Septal Defect
  2. Ventricular Septal Defect
  3. Patent Ductus Arteriosus
63
Q

When does Eisenmenger Syndrome normally present?

A

Ages 10-15 or in adulthood

64
Q

How will a patient with Eisenmenger Syndrome present?

A
  1. Cyanosis
  2. Clubbing
  3. Dyspnoea
  4. Plethoric Complexion
  5. Murmur–> depends on underlying lesion
  6. Pulmonary Hypertension
65
Q

How will a patient with Pulmonary Hypertension present?

A
  1. Right Ventricular Heave
  2. Loud P2
  3. Raised JVP
  4. Peripheral Oedema
66
Q

How would you investigate Eisenmenger Syndrome?

A

Chest X-Ray
ECG
Echocardiogram

67
Q

How would you manage a patient with Eisenmenger Syndrome?

A
  1. Manage underlying condition
  2. Prevention and Early Intervention for high pulmonary blood flow
  3. Heart Transplant
68
Q

What criteria is used to diagnose Rheumatic Fever?

A

Jones Criteria

69
Q

What are the major components of Jones Criteria?

A
  1. Migratory Polyarthritis
  2. Carditis
  3. Erythema Marginatum
  4. Syndenhm Chorea
  5. Subcutaneous Nodules
70
Q

What are the minor components of Jones Criteria?

A
  1. Arthralgia
  2. Fever
  3. 1st degree heart block
  4. Elevated Inflammatory markers (CRP/ESR)
71
Q

What would you need from Jones Criteria to diagnose Rheumatic Fever?

A
  1. 2 Major + evidence of preceding Group A Strep Infection or
  2. 1 Major + 2 Minor + evidence of preceding Group A Strep Infection
72
Q

How would you manage Rheumatic Fever?

A

Acute–> Bed Rest + Anti-inflammatory agents, corticosteroid and Aspirin

Symptomatic Heart Failure–> Diuretics + ACE Inhibitors

Prophylaxis–> Monthly Benzathine Penicillin

Paediatrics and Child Health (5 decks)

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