Cardiology Flashcards
Adolescent routine physical exam, apical midsystolic non-ejection click, and late systolic murmur; the murmur is louder when goes from a supine to a standing position, and the murmur becomes softer when squatting
Mitral valve prolapse
The most common cardiac lesion associated with Noonan syndrome
Pulmonary stenosis and HOCM
A 2-week-old boy develops congestive heart failure, severe metabolic acidosis, and poor perfusion of the lower extremities
Coarctation of the aorta
The most common cardiac lesion associated with trisomy 18
Ventricular septal defect (VSD)
Newborn presents with shock; the echocardiogram shows coarctation of the aorta. What is the drug of choice?
Prostaglandin E1
What are some common side effects of indomethacin?
Thrombocytopenia GI bleeding Necrotizing enterocolitis Renal failure
A 1-day-old newborn presents with cyanosis, single first and second heart sounds, chest radiograph, shows decreased lung markings, and electrocardiogram shows left axis deviation
Tricuspid atresia with pulmonary atresia
Newborn presents with intense cyanosis and respiratory distress, chest radiograph shows a “snowman” shaped heart
Supracardiac total anomalous pulmonary venous return
A 5-year-old, heart rate is 230 beats/min, chest discomfort; the heart rate decreases to 80 beats/ min after ice is applied to the face
Supraventricular tachycardia (SVT)
A 4-year-old boy with physical examination significant for widely split and fixed S2 and crescendo-decrescendo systolic ejection murmur heard in the second intercostal space at the upper left sternal border. EKG shows a RSR1 pattern in V1. What is the most likely diagnosis?
Atrial septal defect
Newborn infant presents with a soft, harsh systolic ejection murmur, best heard at the axillae, and precordium and no symptoms
Peripheral pulmonary stenosis (PPS)
While having her hair brushed, a 15-year-old girl develops cold sweats, pallor, and palpitations and loses consciousness for 10 s
Vasovagal syncope
Child presents with chest pain, fever, friction rub; EKG shows diffuse ST-segment elevation, had upper respiratory infection 10 days before
Pericarditis
A 1-day-old infant with a history of maternal diabetes, cyanosis, and tachypnea, poor response to supplemental oxygen, loud single second heart sound, no murmur, chest radiograph shows narrow mediastinum with small heart tipped on side, increased pulmonary vascularity
Transposition of great vessels
A late complication of an untreated ASD or VSD that results in desaturation
Eisenmenger syndrome—shunt becomes a right to left shunt
Late diastolic rumbling murmur with an opening snap heard at the apex
Mitral valve stenosis
What is the reason that left to right shunt lesions may not present until 1 month of age?
The pulmonary vascular resistance drops to normal levels at that time
Child presents with a history of intermittent tachycardia; EKG shows a short PR interval, slurred and slow rise of the initial upstroke of QRS (delta wave), widened QRS complex
Wolff–Parkinson–White syndrome (WPW)
EKG in a 12-day-old shows negative T wave in V6
Left ventricular hypertrophy
The most common valvular lesion associated with acute rheumatic fever
Mitral regurgitation
A mildly desaturated child with tetralogy of Fallot going in for dental work; is SBE prophylaxis indicated?
Antibiotic prophylaxis
The most common cardiac lesion associated with cri du chat syndrome
VSD
An athlete presents with dyspnea while playing; systolic ejection crescendo- decrescendo murmur best heard at the apex and left sternal border, and radiates to the suprasternal notch; the murmur is louder while standing and with Valsalva maneuver
Hypertrophic cardiomyopathy
The most common cardiac lesion associated with trisomy 21 (Down syndrome)
Endocardial cushion defect
What is the most likely etiology of an early highpitched diastolic murmur associated with bounding pulses in a patient with Marfan syndrome?
Aortic regurgitation
A 6-year-old with a continuous murmur, lowpitched sound, best heard in the infraclavicular region, disappears when supine and with gentle pressure on the jugular vein
Venous hum
The most common cardiac lesion associated with DiGeorge syndrome
Tetralogy of Fallot
EKG shows sinus tachycardia, widened QRS complex with an interval greater than 100 ms, in a child who presents with altered mental status after accidentally ingesting grandmother’s medication
Tricyclic antidepressant (TCA) toxicity
The most common cardiac lesion associated with Williams syndrome
Supravalvar aortic stenosis
The most common cardiac lesion associated with Alagille syndrome
Branch pulmonary stenosis
Child with a previous history of endocarditis; is SBE prophylaxis indicated?
Antibiotic prophylaxis
The most common cardiac lesion associated with lithium teratogen
Ebstein anomaly
Newborn presents with cyanosis in the lower extremities, tachycardia, respiratory distress, and loud single S2 sound
Persistent pulmonary hypertension (R→L shunting across the PDA)
The most common cardiac lesion associated with tuberous sclerosis
Cardiac rhabdomyoma
Adolescent diagnosed with influenza presents with fever, tachycardia, edema, and gallop; chest radiograph shows pulmonary edema, cardiomegaly, low-voltage EKG
Myocarditis
EKG shows progressive prolongation of PR interval followed by a drop in QRS
Second degree AV block (Mobitz I or Wenckebach)
Child routine physical exam, systolic murmur with a vibratory character, best heard in the lower sternal border, varies with changes in respiration and position
Still’s murmur
A 2-year-old with a history of tetralogy of Fallot has progressive agitation, increasing cyanosis, and increased fussiness , no murmur
Hypercyanotic spell (Tet spell)—next step is the knee-chest position
Most common valve abnormality associated with aortic stenosis
Bicuspid aortic valve
Newborn fails hearing screen; EKG shows a very prolonged QT interval
Jervell and Lange- Nielsen syndrome
Newborn presents with severe cyanosis, systolic ejection murmur, and a single second heart sound, chest radiograph shows decreased pulmonary vascular markings
Severe pulmonary stenosis
A 6-month-old infant with failure to thrive, diaphoresis, and hepatomegaly. Echocardiogram shows a large VSD. Next best step?
Surgical correction
What is the next best step in a newborn with suspected transposition of the great vessels?
Prostaglandin E1 to keep the patent ductus arteriosus (PDA) open, followed by +/− balloon atrial septostomy and surgery
An infant of diabetic mother presents a few hours after birth with jitteriness, hypoglycemia, cyanosis; EKG shows prolonged QT interval
Hypocalcemia
The most common cardiac lesion in fetal alcohol syndrome
VSD, ASD
A 12-year-old presents with hypertension, occasional headache, leg cramps, weak and delayed femoral pulse, and blood pressure in the upper limb is higher than the lower limb, chest radiograph shows rib notching and scalloping on the undersurface of posterior ribs
Coarctation of the aorta
The most common cardiac lesion associated with supraventricular tachycardia
Ebstein anomaly
The most common cause of cyanotic heart disease presenting a few days after birth
Transposition of the great vessels
An 8-week-old boy presents with feeding difficulties, poor weight gain, episodes of bluish discoloration of the skin while feeding and crying, a harsh systolic ejection murmur (SEM) is heard over the pulmonic area and left sternal border; chest radiograph shows diminished vascularity in the lungs and diminished prominence of the pulmonary arteries, a boot-shaped heart (cœur en sabot)
Tetralogy of Fallot
The most common cardiac lesion associated with Turner syndrome
Bicuspid aortic valve
The most common congenital cardiac lesion overall
VSD
While running, a 15-year-old girl lost consciousness
Thorough cardiac evaluation and referral to a cardiologist
Child with prosthetic mitral valve going for surgery; is SBE prophylaxis indicated?
Antibiotic prophylaxis
Newborn presents with cyanosis (mother was on a medicine for severe bipolar disorder), chest radiograph shows cardiomegaly and right atrial enlargement
Ebstein anomaly
Child with mitral regurgitation and VSD, going in for dental work. Is SBE prophylaxis indicated?
No antibiotic prophylaxis
What is the most feared complication of Kawasaki disease?
Coronary artery aneurysm
Newborn with cyanosis, pulse oximetry changed from 60% to 88% on 100% O2
Pulmonary (most likely)
An 8-year-old presents with sharp stabbing nonspecific chest pain at rest that resolves shortly. There are no other symptoms and no past medical history
Reassurance (precordial catch syndrome)
The most common cardiac lesion associated with the infant of a diabetic mother
Ventricular hypertrophy
What is the initial management for an obese adolescent with elevated cholesterol levels?
Diet and lifestyle modifications, and if cholesterol is still elevated after 6 months, then start statin
Newborn with cyanosis, pulse oximetry changed from 60% to 64% only on 100% oxygen
Cardiac (most likely)
A girl with Turner syndrome presents with hypertension, weak and delayed femoral pulse
Coarctation of the aorta
What is the definitive treatment for SVT?
Radiofrequency ablation
At what ages is lipid screening universally recommended in the pediatric population?
Once between 9 and 11 and again between 17 and 21
What is the next best step for the newborn with suspected hypoplastic left heart?
Prostaglandin E1
History of repaired VSD with a small residual VSD next to the VSD patch, going in for dental work. Is subacute bacterial endocarditis (SBE) prophylaxis indicated?
Antibiotic prophylaxis
High-pitched holosystolic blowing murmur heard loudest at the apex and radiates to the axilla
Mitral valve regurgitation
During the first 48 h of life, a newborn rapidly develops cyanosis, tachypnea, respiratory distress, pallor, lethargy, metabolic acidosis, oliguria, weak pulses in all extremities, hepatosplenomegaly, and no murmur
Hypoplastic left heart (as PDA closes)
The most common cause of sudden cardiac death in an athlete
Hypertrophic cardiomyopathy
What is the most common organism responsible for infective endocarditis in pediatric patients with or without congenital heart disease?
Staphylococcus aureus
Systolic murmur most commonly heard at the right upper sternal border radiates to the neck and is associated with an ejection click
Aortic stenosis
Late crescendo systolic murmur associated with a mid-systolic click, may be seen in adolescents
Mitral valve prolapse
A 15-year-old boy with a history of recurrent chest pain during exercise faints and dies while playing basketball; hypertrophic cardiomyopathy ruled out as a cause of death. What is the next likely cause?
Anomalous left coronary artery is most likely
A football player presents with chest pain with exertion and several near syncope episodes during his football game. Next best step?
Restrict from sports then EKG and echocardiogram
An asymptomatic adolescent with blood pressure 137/87, all labs normal, renal US and chest radiograph normal. What is the next best step?
Salt restriction in diet
Tall, peaked T waves in precordial leads indicates
Hyperkalemia
The syndrome that is associated with true interrupted aortic arch
DiGeorge syndrome
A 15-year-old girl faints while running and has a positive family history of deafness and sudden death
Long QT syndrome
A premature infant with a continuous machine-like murmur and bounding pulses
PDA
The most common cardiac lesion associated with Holt–Oram syndrome
Atrial septal defect (ASD)
The most common cardiac lesion associated with Marfan syndrome
Aortic root dilation (risk for dissection)
Which medication is used to close a PDA in a premature infant?
Indomethacin
EKG shows normal PR intervals and periodic drop in QRS
second degree AV block (Mobitz II)
A 10-year-old male presents with sharp chest pain; the pain is reproducible on physical exam
Costochondritis
Prophylaxis of IE
