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EOR pediatrics > cardiology > Flashcards

cardiology Flashcards

1
Q

a 9-year old girl is brought to the clinic by her mother on account of fever. She has red skin lesions on the trunk and proximal extremities, and also small, non-tender lumps located over the joints. On further enquiry, she reports a history of sore throat which occurred about 4 weeks ago.

What is your suspected diagnoses? what can you order to help support the diagnoses?

A

Rheumatic fever and you can order an antistreptolysin O titer.

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2
Q

What is the leading cause of mitral valve stenosis and replacement in adults?

A

Rheumatic fever

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3
Q

What is the order in which the heart valves are affected. as in which valve first and so on?

A

Mitral 1st, aortic 2nd, tricuspid 3rd

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4
Q

What bacterial infection usually comes before a child develops rheumatic fever?

A

Strep pharyngitis

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5
Q

The presence of what protein is the most important virulence factor group A streptococcal infection in humans

A

M protein

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6
Q

what are the “major” aspects of jones criteria?

A 
carditis 
chorea 
erythema marginatum 
polyarthritis 
subcutaneous nodules
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7
Q

What are the minor criteria for rheumatic fever?

A 
Arthralgia 
elevated ESR or CRP
fever 
prolonged PR interval 
leukocytosis
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8
Q

Pt with rheumatic fever can develop what kind of heart rythm?

A

A fib

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9
Q

what is the tx for rheumatic fever?

A

penicillin and asa

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10
Q

a healthy 7-year-old girl who has reached all developmental milestones. On examination, the precordium is hyperdynamic with a prominent right ventricular heave. A grade III/VI systolic ejection murmur is present in the 2nd left intercostal space (pulmonic position) with an early to mid-systolic rumble and fixed splitting of the second heart sound (s2) during inspiration and expiration.

What heart issue does the Pt have?

A

ASD

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11
Q

How would you describe the murmur for ASD

A

Wide fixed, split second heart sound. Systolic ejection murmur best heard at the second left intercostal space with an early to mid systolic rumble

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12
Q

How is ASD best diagnosed?

A

Catherization

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13
Q

If pt is symptomatic what meds can you use to treat ASD?

A

Diuretics, ACEI, digoxin

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14
Q

Definitive Tx of ASD would be?

A

surgical closure

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15
Q

an 8-year-old boy who is seen for the first time in your office. His parents report that he tires easily and often complains of weakness in his legs. Physical exam shows a healthy boy with a blood pressure of 141/91 mmHg. You notice that his lower extremities are slightly atrophic with a mottling appearance. Upon further examination, he is found to have very weak and delayed femoral pulses with a blood pressure of 96/60 in the lower extremities

What is the most likely Dx?

A

Coarctation of the Aorta

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16
Q

What kind of murmur would you hear with Coarctation of aorta?

A

late systolic Ejection murmur heard at the aortic area and left sternal border that radiates into the left axilla and left back

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17
Q

What sign on CXR would you see with COA?

A

the 3 sign

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18
Q

What are the key finding of a Pt with COA?

A

elevated BP in the arms with low BP in the legs

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19
Q

The chance of having what kind of aneurysm is increased if you have COA?

A

cerebral berry aneurysm

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20
Q

What is the workup for COA?

A

1- echocardiogram
2- ECG showing LVH
3. CXr- showing the 3 sign aka rib notching

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21
Q

What is the Tx for COA

A

prostaglandins E1

22
Q

a 15-year-old woman presents the ER after a syncopal episode. She had a loss of consciousness 3 times over the past 12 months. Each event occurred during or just after physical exercise. On PE: BP 110/70 mm Hg, HR 75/min, normal S1/S2, and an III/VI systolic ejection murmur is heard best at the left sternal border that decreases with squatting. The EKG shows a normal sinus rhythm with diffuse increased QRS voltage

What are you thinking Dx is?

A

hypertrophic cardiomyopathy

23
Q

What syndrome is HOCM associated with?

A

Marfans syndrome

24
Q

True or False: HOCM is autosomal dominant?

A

True

25
Q

What are some signs and symptoms of HOCM?

A

SOD, Chest pain, syncopal episode after exertion

26
Q

If someone has HOCM and they perform a maneuver that decreases preload, will the murmur increase or decrease?

A

it will increase, so if they increase preload with an action like squatting it will decrease

27
Q

What is the first thing youd order to help diagnose HOCM if you suspect it?

A

an Echo

Can also do an MRI

28
Q

Tx for HOCM?

A

Beta-Blockers + Disopyramide

CCB’s

29
Q

True or false: diuretics are also part of the management for HOCM?

A

False do not use in Pts with HOCM

30
Q

a 5-year-old boy presents to the emergency room with 5 days of fevers, ranging from 102-104°F (38.9-40°C). His mother reports that he also has a bad rash that developed on day 3. On physical exam, he has bilateral conjunctivitis, an extensive morbilliform rash on his trunk with desquamation, a bright red tongue, and swollen hands and feet. Labs are remarkable for elevated C-reactive protein, white blood cell count, and erythrocyte sedimentation rate

What is the likely Dx?

A

Kawasaki disease

31
Q

What should you give immediately if you suspect kawasaki disease?

A

IVIG and aspirin

32
Q

in kawasaki disease is the immune system attacking the veins or arteries?

A

The arteries

33
Q

What is the mnemonic used to help remember the symptoms of kawasaki disease?

A

CRASH AND BURN (FEVER)

34
Q

What does CRASH stand for in kawasaki?

A

C- conjunctival injection (spares limbus)
R- rash all body parts (flakes)
A- Adenopathy (enlarged cervical lymph nodes)
S- strawberry tongue
H- hand and foot rash

Fever- last for 5 days and does not resolve with medications

35
Q

What are some cardiac sequela from kawasaki disease?

A

coronary artery aneurysm
myocarditis
MI

36
Q

How many of the CRASH symptoms do you need to have to diagnose KD

A

4 or 5 plus lasting fever

37
Q

What is one test all Pts with KD should get?

A

An echo to rule out cardiac abnormalities

38
Q

When would you repeat an echo for someone who had KD?

A

2 weeks after diagnoses and then 6-8 weeks

39
Q

What labs are elevated in KD.

A

Pretty much all inflammatory markers

ESR
CRP 
Platlets 
WBC with left shit 
Liver transaminase
40
Q

a 2-week-old infant with a history of prematurity presents with a pink torso and upper extremity and blue lower extremities. On cardiac auscultation, you notice a rough, continuous “machinery murmur” heard over the left sternal border at the 2nd intercostal space

What is the likely Dx? What study would you order first to confirm?

A

PDA an ECHO

41
Q

How can an infant present if they have a PDA?

A

tachypnea, difficulty feeding, no weight gain, diaphoresis

42
Q

Which NSAID has been used to close a PDA?

A

indomethacin

43
Q

What should be included in the workup for syncope?

A

ECG, glucose, echo, pulse Ox, tilt table

CNS imaging but thats rare

44
Q

a 2-week-old newborn brought to the ER by his mom who reports a sudden loss of consciousness during feeding and with crying. She also has noticed that the infant’s lips have turned blue on three occasions during feeding

What is the most likely Dx?

A

tetralogy of fallot

45
Q

If you ordered an X-ray on an infant with tetralogy of fallot what would it show?

A

a small boot shaped heart

46
Q

What kind of murmur would be heard with tetralogy of fallot?

A

A grade 3/6 harsh systolic ejection murmur is heard at the left upper sternal border.

Crescendo-decrescendo, holosystolic at LSB radiating to the back

47
Q

The four features of tetralogy of fallot are?

A

PROV

Pulmonary stenosis
Right ventricular hypertrophy
overriding aorta
Ventricular septal defect

48
Q

a 4-year-old boy who is brought to your office by his parents because he gets tired very easily and cannot keep up with the other children. On exam, you hear a loud, harsh, holosystolic murmur at the left lower sternal border without radiation to the axillae

What is the likely Dx?

A

VSD

49
Q

VSD can lead to what?

A

Pulmonary hypertension

50
Q

Most VSDs close by which age?

A

age 6

EOR pediatrics (9 decks)

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