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1 Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

List three red flags in cardiovascular system

A

 Breathing Difficulty
 Cough
 Wheeze
 Cyanosis
 Lethargy
 Murmur

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2
Q

After what age does finger clubbing become apparent?

A

> 1 year

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3
Q

Which organ aside from the heart can become enlarged in heart failure?

A

liver

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4
Q

List two features of an innocent murmur

A
  1. Asymptomatic
  2. No thrill/no heave
  3. Soft systolic murmur
  4. Varies with position
  5. Localised to one area
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5
Q

List three acyanotic congenital heart conditions

A
  1. Ventricular septal defect (VSD)
  2. Pulmonary stenosis
  3. Atrial septal defect (ASD)
  4. Coarctation of the aorta
  5. Patent ductus arteriosus (PDA)
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6
Q

State three cyanotic congenital conditions

A
  1. Tetralogy of Fallot
  2. Transposition of the great arteries
  3. Tricuspid atresia
  4. Pulmonary atresia
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7
Q

List three differentials for cyanosis

A
  1. Respiratory disease
  2. Cardiac
  3. During a seizure
  4. Stress: infection, hypoglycaemia, adrenal crises
  5. CNS depression: drugs, trauma, asphyxia
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8
Q

List three common causes of cardiac failure in children

A
  1. Anaemia
  2. Fluid overload
  3. Stress- infection, hypoxia, acidosis
  4. Cardiac- VSD, AVSD, cardiomyopathy
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9
Q

List three cardiac causes of cardiac failure in children

A

VSD, AVSD, cardiomyopathy, coarctation of the aorta

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10
Q

Name two chromosomal abnormalities associated with cardiac conditions

A

down’s
edward’s
turner’s
patau’s
di george

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11
Q

How does atrial septal defect present?

A

breathlessness and arrhythmia

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12
Q

What is the outlook of atrial septal defect?

A

good long term outlook

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13
Q

How many asymptomatic/small VSD close spontaneously?

A

80%

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14
Q

Name a physiological complication of a large VSD?

A

left ventricular overload and increase pulmonary blood flow, leading to cardiac failure

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15
Q

What are the clinical findings in patent ductus arteriosus?

A

bounding femoral pulses and continuous left subclavicular murmur

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16
Q

Two complications of patent ductus arteriosus?

A

heart failure and failure to thrive

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17
Q

How does coarctation of aorta present in neonates?

A

collapse, cardiac failure or weak/absent femoral pulses

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18
Q

How does coarctation of aorta present in older children/adults?

A

raised blood pressure/absent femoral pulses or radio-femoral delay

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19
Q

Which is the most common neonatal cyanotic condition?

A

transposition of the great arteries

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20
Q

Where does mixing of blood occur in transposition of the great arteries?

A

atrial level and arterial duct

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21
Q

What are the four features of tetralogy of fallot?

A

RAPS
Right ventric hypertrophy
Aorta displacement/overriding aorta
Pulmonary stenosis
Septal defect (ventricular)

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22
Q

Two risk factors for patent ductus arteriosus?

A

premature birth
maternal rubella

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23
Q

Which is the most likely organism to cause infective endocarditis in children?

A

strep viridans

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24
Q

Name three symptoms of infective endocarditis

A

fever, malaise, weight loss, haematuria, splenmogealy, arthralgia

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25
Q

Does a negative echo exclude infective endocarditis?

A

no

26
Q

What is a Tet spell?

A

rapid drop in amount of oxygen in the blood, obstruction of right ventricular outflow

27
Q

What is the management of a Tet spell?

A

lift knee to chest or squat (increases systemic vascular resistance)

28
Q

Why do toddler squat during a tet spell?

A

increases blood flow to lungs as afterload is increased, increasing pressure in aorta, less shunting

29
Q

Which class of drug is administered in tetralogy of fallot to keep ductus arteriosus open?

A

prostaglandin

30
Q

Why is tetralogy of fallot a misnomer?

A

it’s due to a single pathological cause, where the septum shifts to the right, which results in four complications

31
Q

Which shunt occurs in tetralogy of fallot?

A

right to left (due to pulmonary stenosis, RV hypertrophy, high pressure), therefore mixing of deoxygenated blood- cyanosis

32
Q

Baby with single palmar crease, upslanting palpebral fissures, flattened facial features. 3/6 pansytolic murmur at left sternal edge. What is the likely congenital defect?

A

AVSD

33
Q

What percentage of down’s syndrome babies will have AVSD?

A

40-60%

34
Q

3 year old with two day history of coryza, sore throat, intermittent fevers. She is pyrexial and tachy on exam. She has a systolic murmur in left lower sternal edge which disappears when the patient sits forward. What is the likely cause of the murmur?

A

Innocent heart murmur= functional heart murmur, classically change with position, don’t worry about this at all.

35
Q

Name one trigger for innocent murmur?

A

infection

36
Q

Baby girl with 2/6 soft systolic murmur radiating to back. Femoral pulses are weak. She appears pink and well perfused. What is the underlying cardiac issue in this baby?

A

Coarctation of the aorta

37
Q

Which syndrome is associated with coarctation of the aorta?

A

turner’s

38
Q

Name three features of Turner’s syndrome

A

webbed neck, widely space nipples, short stature

39
Q

What is the definitive treatment of transposition of the great arteries?

A

arterial switch surgery (prostaglandins are given initially but is only temporary, keeps the ductus arteriosus patent).

40
Q

Which is the most common cyanotic congenital heart defect?

A

transposition of the great arteries

41
Q

CXR shows egg shaped heart. What is the likely diagnosis?

A

transposition of great arteries

42
Q

Boot shaped heart on CXR. what is the likely condition?

A

Tetralogy of fallot. What causes the boot shape? Normal sized heart with upturned apex. Echo confirms diagnosis. Second most common cyanotic condition.

43
Q

Two causes of splitting of S1?

A

=differential contraction of left and right ventricles (mitral and tricuspid valves)

mechanical:
atrial septal defect
tricuspid stenosis

conduction:
RBBB

44
Q

What causes splitting of S2?

A

can be normal variant- inspiration= normal
mechanical or conduction causes

45
Q

Barbara is a term baby, who was borderline small for dates during pregnancy. Mum was otherwise well and didn’t take any medications. At her baby check the following is noted: hands/feet appear swollen, excess skin around the neck, 3/6 ejection systolic murmur (loudest at the top of the sternum).What is the most likely cardiac abnormality?

A

VSD

46
Q

A GP has noted a new cardiac murmur in a baby’s 6 week check. Which single feature is most suggestive of a pathological murmur

A

is accompanied by hepatomegaly (3cm below costal margin)

47
Q

What are the 6 S’s of innocent murmurs?

A

Soft (not >3/6)
Sensitive (changes with position)
Systolic
Short (i.e. not pansystolic)
Single (no other added sounds, usually one location, no other symptoms and signs)
Sweet (i.e. not harsh sounding)

48
Q

Name one example of an innocent murmur

A

Still’s murmur
Venous hum

49
Q

Which innocent murmur is louder lyind down and which louder when standing up?

A

lying down- still’s

standing up- venous hum

50
Q

A baby boy born prematurely at 29+3 is on the NICU and is now 2 weeks old. The doctors are struggling to wean him off of the ventilator. Antenatal scans were normal. The chest is clear, but a continuous ‘machine like’ murmur is noted at the left upper sternal edge, which radiates to the back.Which is the most likely lesion found on echocardiogram?

A

patent ductus arteriosus

51
Q

How is murmu in VSD described?

A

pansytolic, harsh sounding, LLSE

52
Q

How is murmur in tetralogy of fallot described?

A

ejection systolic

53
Q

6 Cyanotic congenital heart disease?

A

5 T’s and an H
TGA
TOF
Truncus arteriosus
Tricuspid atresia
TAPVD
HLHS

54
Q

The CXR appearance ‘egg on a string’ is indicative of what?

A

transposition of great arteries

55
Q

Matilda is 6 weeks old. She is referred to general paediatrics for falling off of her weight centiles. Mum says she is a poor feeder, and is now only managing a few minutes at a time. On examination there is hepatomegaly and a harsh systolic murmur. What is the most likely cardiac lesion?

A

VSD

56
Q

List four cause of heart failure in child

A

Congenital Heart Disease
-Left to Right Shunt (VSD/AVSD)
-Obstruction (Co-Arctation of the Aorta)
Cardiomyopathy
Myocarditis
Endocarditis
Tachyarrhythmias
Ischaemic Heart Disease: Kawasaki Disease
Hypertension: Renal Disease
High Output: Anaemia / Thyrotoxicosis

57
Q

Annie is a 2 day old who is brought into A&E by ambulance blue and floppy. She is still breathing but looks very unwell. She has good brachial pulses but no femoral pulses on examination. She has a normal blood pressure when taken from her upper limbs. What is the most appropriate initial management plan?

A

Prostaglandin E2

58
Q

You see T wave inversion in ECG of child in V1-V3. Are you worried?

A

no as this is typical in younger children. If you saw this in adult you would be concerned for ischaemia (V1 T wave inversion is normal)

59
Q

When does coarctation of the aorta present?

A

25% detectable from birth birth due to severity of narrowing of aorta

the majority will present later on in childhood

60
Q

How does coarctation of the aorta present?

A

respiratory distress
collapse
weak or absent femoral pulses

61
Q

Which medication must be given to child awaiting surgery for transposition of the great arteries?

A

Prostaglandin E1 should be given to maintain a patent ductus arteriosus in cyanotic congenital heart diseases
ALPROSTADIL

1 Paediatrics (19 decks)

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