Cardiology

Question 1

Egg on a string

Answer 1

Transposition of the Great Arteries

Question 2

Boot-shaped heart

Answer 2

Tetralogy of Fallot

Question 3

Four structural heart defects in ToF

Answer 3

1. Overriding Aorta (aorta goes anterior to septal wall)
2. VSD
3. Pulmonic stenosis/outflow obstruction
4. Right ventricular hypertrophy

Question 4

Pathophysiology behind Tet spells

Answer 4

Increased R –> L shunting across VSD leading to circulation of deoxygenated blood; can overcome this by increasing venous return/systemic vascular resistance to overcome shunt

Question 5

Most common cyanotic heart disease to present in the newborn period?

Answer 5

Transposition of the Great Arteries

Question 6

Most common cyanotic congenital heart disease in general?

Answer 6

Tetralogy of Fallot (but usually presents around 3-5 months of age, not immediately).

Question 7

ASD murmur?

Answer 7

Fixed wide split of S2, loudest at the LUSB due to increased flow across the pulmonary valve

Question 8

SEM audible at the LUSB with thrill radiating to the back, varies with respiration

Answer 8

Pulmonic stenosis

Question 9

SEM audible at the RUSB with thrill at the sternal notch, does not vary with respiration?

Answer 9

Aortic stenosis

Question 10

A single second heart sound

Answer 10

Tetralogy of Fallot (pulmonic valve sound virtually absent)

Question 11

During a Tet spell, which of the two is correct?

• Previous murmur is not audible
• Auscultation of a new murmur

Answer 11

Previous murmur (pulmonic stenosis murmur) is not audible because of lack of RV outflow

Question 12

Which heart diseases presents with a single S2 heart sound? How can you differentiate the two HDs?

Answer 12

Tetralogy of Fallot (virtually minimal pulmonic outflow so no natural delay in P2 sound) & TGA
ToF– decreased pulmonary vascularity
TGA– increased pulmonary vascularity

Question 13

CHD where lower extremity sats may be higher than the upper extremity sats?

Answer 13

Transposition of the great arteries–

1) RV –> aorta (upper extremities
(2) LV–> pulmonary artery –> PDA –> (lower extremities)

Question 14

William Syndrome heart defect?

Answer 14

Supravalvular aortic stenosis

Question 15

Noonan Syndrome heart defect?

Answer 15

Supravalvular pulmonic stenosis

Question 16

Turner Syndrome heart defect?

Answer 16

Bicuspid aortic valve, coarctation of the aorta

Question 17

22q11 deletion related heart defect?

Answer 17

Conotruncal defects and VSD

Question 18

Down Syndrome related heart defect?

Answer 18

AV canal defects

Question 19

Marfan Syndrome related heart defect?

Answer 19

Aortic root dissection, mitral valve prolapse

Question 20

Features of WPW and increased risk for precipitating what type of arrhythmia?

Answer 20

Shortened PR interval and delta wave, risk for precipitating SVT

Question 21

Digoxin and other AV nodal agents (beta-blockers, Ca-channel blockers) are contraindicated in the management of which arrhythmia?

Answer 21

SVT or A-fib in WPW; can slow down the normal signal conduction through the AV node and promote signal conduction down the accessory pathway–> can lead to SVT–> VT/Vfib

Question 22

Why is prolonged QT interval bad?

Answer 22

If the next heart beats starts before the last ends–> disorganized rhythms such as pulseless VT or V-fib

Question 23

Most common murmur to occur with Rheumatic Fever?

Answer 23

Mitral valve regurgitation

Question 24

Major and minor JONES criteria?

Answer 24

Acute Rheumatic Fever

Major– Polyarthritis, Carditis, Subcutaneous Nodules, Erythema marginatum, Sydenham Chorea (just chorea itself may be enough to diagnose ARF)

Minor- High Temp, Elevated ESR, ArthraLgia, Prolonged PR interval (HELP)

1 major and 2 minor or 2 major; also history of Strep + sydenham chorea also enough

Question 25

How to treat ARF?

Answer 25

PCN, aspirin (for fever and joint pain), +/- steroids for carditis; Haldol for chorea

Question 26

What test do you order to diagnose endocarditis?

Answer 26

Blood culture (not echo); you have to isolate the pathogen in the blood

Question 27

Pulsus paradoxus is seen in which heart conditions?

Answer 27

Pericarditis, pericardial tamponade, pericardial effusion; drop in the SBP by more than 10mmHg with inhalation

Question 28

What is cardiac tamponade?

Answer 28

When enough fluid fills the pericardial sac to prevent proper filling of the heart (especially affects right heart filling).

Question 29

Radiologic sign for TAPVR?

Answer 29

Snowman sign-- blood from the pulmonary vein drains into the RA instead of the LA--> causes out-pouching of the SVC and right ventricular border, as well as collateral vessels

Question 30

Five cyanotic congenital heart diseases?

Answer 30

``` Truncus arteriosus TGA Tricuspid atresia Tetralogy of Fallot TAPVR ```

Question 31

Boxed-shaped heart is a radiographic description describing what heart disease?

Answer 31

Ebstein's anomaly

Question 32

Description of wall-to-wall heart with decreased pulmonary markings?

Answer 32

Tricuspid regurgitation 2/2 Ebstein's anomaly (also described as a box shaped heart)

Question 33

What is the most common cause of SVT in an infant vs in an older child/adolescent?

Answer 33

AVRT (infant/neonate) vs AVnRT (older child/adolescent)

Question 34

True or False-- HOCM is an inherited condition

Answer 34

True-- autosomal dominant mutation in sarcomere proteins (myosin, troponin)

Question 35

Persistent stridor and concerns of difficult swallowing solids?

Answer 35

Pulmonary sling (the left pulmonary artery branches distally off of the right PA and goes in between the trachea and the esophagus, compressing the esophagus); normally both PAs branch off of the main PA and pass in front of the trachea

Question 36

Definition of prolonged QTc?

Answer 36

QTc >0.45 seconds

Question 37

What is the treatment for prolonged QT?

Answer 37

Beta-blocker (propranolol)--> slows down conduction through the AV node to prevent firing of a new action potential prior to ventricular repolarization; prolonged QT causes prolonged ventricular repolarization and there is the risk of an AP firing prior to the ventricles completing repolarization

Question 38

What stimulus can trigger an arrhythmia in a patient with prolonged QT?

Answer 38

Sudden emotions, startling, exercise (syncopal episodes, can also see seizures due to loss of blood supply to the brain)

Question 39

Why does amiodarone and procainamide work for stopping SVT if adenosine does not work?

Answer 39

Both medications with prolong ventricular repolarization

Question 40

Infective Endocarditis prophylaxis indications?

Answer 40

1. Complete repair of cyanotic heart disease, even if repaired with prosthetic material-- only for the first 6 months after repair 2. Heart transplant with a residual cardiac valve defect 3. Prosthetic heart valves 4. Unrepaired cyanotic heart disease 5. Repaired cyanotic heart disease with residual defect at or near the site of prosthetic material

Question 41

What type of procedures is infective endocarditis prophylaxis indicated for?

Answer 41

Dental procedures or procedures involving manipulation of oral or respiratory mucosa; not indicated for GI/GU procedures.

Question 42

Pattern of T-wave inversion per age group?

Answer 42

Starts off upright in right precordial leads, then inverted in right leads after 1 week of life, then back to being upright in later childhood/adolescence

Question 43

Drugs that can induce drug-induced lupus?

Answer 43

Procainamide and Hydralazine

Question 44

rsR' pattern in V1-V4

Answer 44

RVH

Question 45

Greater S waves than R waves in V1-4

Answer 45

LVH