Cardiology

Question 1

Causes of right ventricular hypertrophy

Answer 1

ASD

Question 2

SVT with poor perfusion

Answer 2

Synchronized cardioversion (adenosine used for stable SVT)

Question 3

Most common cardiac cause of cyanosis in newborn period

Answer 3

Transposition of great arteries (TOF more common overall, but usually presents after 1st few months of life)

Question 4

2/6 systolic ejection murmur best heard at the 2nd intercostal space left of sternum with a wide, fixed splitting of the 2nd heart sound

Answer 4

Atrial septal defect => increase volume from right ventricle causes an ejection murmur over pulmonic valve. Sometimes associated with soft diastolic rumble over tricuspid valve area. (NOT pulmonic stenosis which is more harsh and does NOT have fixed splitting of S2)

Question 5

Harsh systolic ejection murmur heard best at LUSB, with systolic click immediately following 1st heart sound during expiration

Answer 5

Pulmonic stenosis (Noonan syndrome and Williams Syndrome)

Question 6

Systolic ejection murmur best over 1st and 2nd left intercostal space with widely split and fixed 2nd heart sound

Answer 6

ASD

Question 7

Long QT syndrome treatment

Answer 7

Beta-blockers (by preventing ventricular arrhythmias and blocks sympathetic surges), pacemaker, internal cardioverter-defibrillator, and/or ablation of sympathetic innervation

Question 8

Normal T wave direction

Answer 8

T waves all update up to 1 week of life, then right precordial leads become inverted (V4R and V1), then in early adolescent becomes upright again. If right precordial leads are upright between in toddler or early school age, may suggest RVH

Question 9

New diagnosed hypertrophic cardiomyopathy (tx)

Answer 9

Beta blocker such as propranolol (decrease heart rate => increase LV fill time in diastole => decrease LVOF obstruction); and no competitive sports