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1. Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

[Cardiology/PE/murmur]

Affects of maneuvers to Hypertrophic Cardiomyopathy

Valsalva: ___
Standing: ___
Passive leg raise: ___
Handgrip: ___

A

Valsalva (dec LV filling): increase murmur
Standing (dec VR): increase murmur
Passive leg raise (inc VR): decrease murmur
Handgrip (inc PVR): decrease murmur

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2
Q

[Cardiology/PE/murmur]

Affects of maneuvers to Mitral Valve Prolapse

Valsalva: ___
Handgrip: ___

A

Valsalva: Click moves earlier
Handgrip: Click moves later

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3
Q

[Cardiology/PE/murmur]

Which murmur?

Soft, musical quality, systolic
Louder in supine, anemia, or fever
Softer with standing, Valsalva

A

Innocent murmurs

(HCM murmur increases with standing, valsalva)

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4
Q

[Cardiology/EKG]

Normal durations of intervals

PR: ___
QRS: ___
QTc: ___ % of RR
- < 15 years: ___
- > 15 years: ___

A

PR: 1 big square, 200 ms
QRS: 1/2 big square, 100 ms
QTc: ~40% of RR
- < 15 years: 460 ms
- > 15 years: men 450 ms, women 460 ms

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5
Q

[Cardiology/arrhythmia/WPW]

Treatment of choice for A-fib or A-flutter with WPW?

A

IV Procainamide

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6
Q

[Cardiology/arrhythmia/WPW]

Treatment of choice for stable VT?

A

Amiodarone

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7
Q

[Cardiology/anti-arrhythmics]

Which anti-arrhythmic side effect?

Torsades de pointes, dairrhea, autoimmune thrombocytopenic purpura
Cichonism: hearing loss, tinnitus, psychosis

A

Quinidine (Class Ia)

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8
Q

[Cardiology/anti-arrhythmics]

Which anti-arrhythmic side effect?

Agranulocytosis, neutropenia, thrombocytopenia
Drug-induced SLE: fever, arthralgia, pericarditis

A

Procainamide (Class Ia)

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9
Q

[Cardiology/anti-arrhythmics]

Which anti-arrhythmic side effect?

If used chronically,

Corneal deposits
Hepatic toxicity
Hyper/hypothyroidism, hepatic toxicity
Pulmonary fibrosis
Gray skin, sun sensitivity

A

Amiodarone (Class III)

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10
Q

[Cardiology/arrhythmia/long QT]

Congenital long QT syndrome differentiation

Romano-Ward syndrome:
- Autosomal ____
- Without or With sensorineural hearing loss

Jervell and Lange-Nielsen syndrome:
- Autosomal ____
- Without or With sensorineural hearing loss

A

Romano-Ward syndrome:

  • Autosomal Dominant
  • Without sensorineural hearing loss

Jervell and Lange-Nielsen syndrome:

  • Autosomal Recessive
  • With sensorineural hearing loss
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11
Q

[Cardiology/arrhythmia/AV block]

2 degree AV block
- PR Prolongation and drop: Mobitz ___, treatment: ___
- Periodical drop: Mobitz ___, treatment: ___

A

2 degree AV block

  • PR Prolongation and drop: Mobitz 1, treatment: no
  • Periodical drop: Mobitz 2, treatment: pacemaker (if symptomatic)
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12
Q

[Cardiology/arrhythmia]

Causes of this EKG (3)?

A

3rd degree AV block

  • Infant of mother with SLE
  • Lyme carditis
  • Hyperkalemia
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13
Q

[Cardiology/arrhythmia]

Most common cause of this EKG?

A

RBBB

  • Open-heart surgery
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14
Q

[Cardiology/CHD]

Associated congenital heart diseases?

Lithium: ___
Ethanol: ___
Antiseizure: ___
Retinoic acid: ___
Diabetes: ___
Lupus: ___

A

Lithium: Ebstein anomaly
Ethanol: ASD, VSD
Antiseizure: PS, AS, TOF
Retinoic acid: transposition
Diabetes: HCM
Lupus: complete heart block

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15
Q

[Cardiology/CHD]

Associated congenital heart diseases?

Noonan: ___
Alagille: ___
William: ___
Turner: ___
22q11.2: ___

A

Noonan: PS
Alagille: PS
William: Supravalvular AS
Turner: CoA, bicuspid AV
22q11.2: Truncus arteriosus, interrupted aortic arch, TOF

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16
Q

[Cardiology/CHD/LtR/VSD]

Most common type of VSD

  • < 1 years old: ___
  • > 1 years old: ___
A
  • < 1 years old: muscular septum
  • > 1 years old: perimembranous septum
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17
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease and treatment?

At 3-4 weeks of age
Sx: FTT, frequent respiratory infection
M: Holosystolic murmur with thrill at LLSB
CXR: increased pulmonary vasculature
EKG: LVH, if prolonged RVH

A

Ventricular septal defect

Treatment:

  • If asymptomatic, wait till 6 months
  • If symptomatic and perimembranous or muscular: medical therapy and surgery 3-5 years old
  • If symptomatic and large: surgery
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18
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease and treatment by age?

Premature infants
M: Rumbling, machinery like, at left clavicle, radiate to the back
PE: Bounding pulses, wide pulse pressure
CXR: cardiomegaly, increased pulmonary markings
ECG: LVH

A

Patent ductus arteriosus

Treatment:

  • Infants: ibuprofen, indomethacin
  • Older: catheter, surgery
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19
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease, and its type and treatment age?

Sx: Most asymptomatic, HF > 20-30 years of age if undiagnosed
Female>Male
M: Systolic cresendo decrescendo, wide fixed S2, at LUSB, mid-diastolic murmur
CXR: right atrium, ventricle, pul artery enlargement
ECG: RAD, RVH, rsR’ or rSR’

A

Atrial Septal Defect
Ostium Secundum Defect

Treatment:

  • Closure by 5 years of age
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20
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease, and its type and treatment age?

Sx: HF < 5 years of age
M: cresendo decresendo, wide fixed S2, at LUSB
CXR: right atrium, ventricle, pul artery enlargement
ECG: LAD, RVH

A

Atrial Septal Defect
Ostium Primum Defect
(Partial AV defect)

Treatment:

  • Surgical correction ≤ 1-2 years old
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21
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease and treatment age?

Sx: HF by 2 months old
M: Holosystolic at LLSB, mid-diastolic at apex
ECG: severe LAD, biventricular hypertrophy
CXR: cardiomegaly, increased pulmonary flow
Associated with Down syndrome

A

Complete AV canal defect

Treatment:

  • Surgical correction < 6 months
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22
Q

[Cardiology/CHD/RtL/TOF]

4 components of tetralogy of Fallot

A
  1. VSD
  2. RV outflow tract obstrction (PS or subpulmonic stenosis)
  3. Overriding aorta
  4. RVH
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23
Q

[Cardiology/CHD/RtL/TOF]

For Tetralogy of Fallot

Worsening cyanosis: ___
Improving cyanosis: ___

A

Worsening cyanosis:

  • Increase PVR (Valsalva, screaming)
  • Decrease SVR (eating, heat)

Improving cyanosis:

  • Increase SVR (squatting)
  • Decrease PVR (calming down)
24
Q

[Cardiology/CHD/RtL/TOF]

Medical treatment for Tetralogy of Fallot?

Acute: ___
Tet preventive: ___

A

Acute:

  • Oxygen: decrease PVR
  • β-blocker: decrease HR, increase RV filling
  • Morphine: decrease HR

Tet Preventive:

  • Propranolol
25
# [Cardiology/CHD] Typical CXR finding: CoA: ___ Ebstein: ___ TOF: ___ TGA: ___ TAPVR: ___
CoA: figure 3 Ebstein: box-like TOF: boot-shaped TGA: egg-shaped TAPVR: snowman
26
# [Cardiology/CHD/RtL/TOF] Associated genetic syndrome with Tetralogy of Fallot (3)?
1. Trisomies, 21, 13 and 18 2. Alagille syndrome 3. CHARGE syndrome
27
# [Cardiology/CHD/LtR] Acyanotic heart disease (Left to Right shunt) (4)?
1. VSD 2. ASD, PFO 3. PDA 4. Complete AV canal defect
28
# [Cardiology/CHD/RtL] Cyanotic heart disease (Right to Left shunt) (4)?
1. TOF 2. TGA 3. Tricuspid Atresia 4. Pulmonary atresia with intact ventricular septum
29
# [Cardiology/CHD/LtR] Cyanotic heart disease (Other mixing) (3)?
1. Truncus Arteriosus 2. TAPVR 3. HLHS
30
# [Cardiology/CHD/RtL] Which Congenital heart disease and acute treatment? Sx: Cyanosis in the few hours of life PE: single loud S2, no murmur (or VSD murmur later) ECG: positive T wave in V1 (RVH) CXR: egg-shaped
Transposition of the Great Arteries Acute management: - PGE1 - ballon atrial septostomy
31
# [Cardiology/CHD/RtL] Which Congenital heart disease? Sx: Cyanosis in the few hours of life M: VSD or PS murmur EKG: Left Superior axis (0 to -60) deviation, LVH
Tricuspid Atresia TA: Superior axis (0 to -60) / PA: Inferior (0 to 90) axis
32
# [Cardiology/CHD/Cyanotic] Which Congenital heart disease? Sx: Cyanosis in the few hours of life M: no murmur EKG: Left Inferior axis (0 to 90) deviation, LVH
Pulmonary atresia with intact ventricular septum TA: Superior axis (0 to -60) / PA: Inferior (0 to 90) axis
33
# [Cardiology/CHD/Mixing] Which Congenital heart disease? Sx: HF in the first few weeks of life M: hyperdynamic, single S2, ejection click CXR: Cardiomgaly EKG: RVH, biventricular hypertrophy Associated with DiGeorge syndrome
Truncus arteriosus (Needs FISH test for 22q11 deletion)
34
# [Cardiology/CHD/Mixing] Which Congenital heart disease? Sx: Tachypnea, FTT Or pulmonary edema, severe cyanosis CXR: snowman
Total Anomalous Pulmonary Venous Return (TAPVR)
35
# [Cardiology/CHD/Mixing] Which congenital heart disease, type doesn't respond to PGE1?
TAPVR, infradiaphragmatic form
36
# [Cardiology/CHD/Mixing] Which Congenital heart disease? Sx: Acute HF in the first few weeks M: no murmur, loud S2, PE: poor pulses, hyperdynamic RV, gray color CXR: cardiomegaly, pulmonary edema ECG: RA, RV hypertrophy
Hypoplastic Left Heart Syndrome
37
# [Cardiology/CHD/Obst] Which heart disease? Sx: Shock in a few weeks of life M: Harsh systolic ejection murmur at RUSB, Click at apex PE: All pulses diminished, low BP CXR: cardiomegaly, pul edema EKG: LVH, LV strain (ST depression in left lateral)
Aortic stenosis
38
# [Cardiology/CHD/Obst] Which heart disease? Sx: Cyanosis in infancy M: ejection click after 1st HS, systolic, at LUSB, radiating to left clavicle, back, EKG: peaked P waves (RA enlargement), RAD, RVH CXR: RV prominence
Pulmonary stenosis
39
# [Cardiology/CHD/Obst] Which heart disease? Sx: HF, pulmonary edema in infancy M: apical systolic ECG: broad P waves (LA enlargement), RVH Associated with rheumatic fever
Mitral stenosis
40
# [Cardiology/CHD/Obst] Which heart disease and treatment? Sx: Dyspnea on exertion, chest pain, syncope, sudden death in athletes M: systolic, cresendo-decresendo, at LMSB, louder with Valsalva, softer with squat ECG: LVH, negative T in V6
Hypertrophic cardiomyopathy (AS murmur gets louder with squat) Treatment: - β-blocker for maintenance - myectomy if severe
41
# [Cardiology/CHD/Regurg] Causes of aortic regurgitation (4)?
Bicuspid aortic valve (Turner) Marfan RF Infective endocarditis
42
# [Cardiology/PE/Murmur] RUSB: ___ LUSB: ___ L, 3rd ICS: ___ LLSB: ___ Apex: ___
RUSB (Aortic) - Systolic: AS, flow murmur LUSB (Pulmonic): - Systolic: PS, ASD, flow murmur LL 3rd ICS (Erb): - Diastolic: AR, PR - Systolic: HCM LLSB (Tricuspid): - Holosystolic: VSD, TR - Diastolic: TS Apex: - Systolic: MR, MVP - Diastolic: MS
43
# [Cardiology/CHD/Regurg] Conditions associated with Mitral Valve Prolapse (4)?
Marfan Ehlers-Danlos Mucopolysaccharidosis Anorexia nervosa
44
# [Cardiology/RF] Jones criteria for Rheumatic Fever (5)?
**J**oint (polyarthritis, migratory) **♡** Carditis **N**odules, subcutaneous **E**rythema marginatum **S**ydenam Chorea
45
# [Cardiology] ___ bodies are pathognomic for ___ (Palisading giant cells with areas of swelling, granulomatous inflammation in cardiomyocytes)
_Aschoff bodies_ are pathognomic for _Rheumatic Fever_
46
# [Cardiology/RF] Serologic test for Rheumatic fever (5)?
Anti streptolysin O (ASO) Anti-deoxyribonuclease B (anti-DNase B) Anti-hyaluronidase Anti-streptokinase Anti-nicotinamide adenine dinucleotidase (anti-NADase)
47
# [Cardiology/IE Prophylaxis] Disease indication for infective endocarditis prophylaxis (4)?
1. Prosthetic (mechanical and bio) cardiac valve, completely repaired CHD with prosthetics for _6 months_ postprocedure 2. Previous history of endocarditis 3. Unrepaired cyanotic heart disease, Repaired CHD with residual lesion 4. Cardiac transplant with cardiac valvulopathy
48
# [Cardiology/IE Prophylaxis] Procedure indication for infective endocarditis prophylaxis (3)?
1. Dental 2. Respiratory 3. Infected skin (Not for GU or GI)
49
# [Cardiology/IE Prophylaxis] Choice of antibiotics for infective endocarditis prophylaxis?
PO: Amoxicillin (Standard) once 1 hour before procedure IV: Ampicillin (If allergic, clindamycin, cephalexin)
50
# [Cardiology/CM] Which cardiomyopathy and treatment? Sx: infants, toddlers with fatigue, shortness of breath, ankle swelling PE: low BP, weak pulses, increased HR and RR, elevated jugular pulses
Dilated cardiomyopathy Treatment - Diuretics and ACEi
51
# [Cardiology/Pericardial] Diagnosis and treatment? Following open ASD repair (or other surgical repair) Pericardial friction rub, muffled heart sound, fever Increased ESR
Postpericardiotomy syndrome Treatment: - Aspirin
52
# [Cardiology/HF] Timing of HF presentation 1st week of life: ___ 4-8 weeks of life: ___ 6-8 years of life: ___
1st week of life: left heart obstruction (CoA, HLHS) 4-8 weeks of life: L to R shunt (VSD, AVSD) 6-8 years of life: acquired (RF, myocarditis)
53
# [Cardiology/HF/Treatment] Side effects? Preload reduction: diuretics 1. Loop diuretics: furosemide 2. Cortical diluting: thiazides, metolazone 3. K-sparing: Spironolactone
Preload reduction: diuretics 1. Loop diuretics: furosemide - hypokalemia, hypochloremia, hyponatremia, metabolic alkalosis 2. Cortical diluting: thiazides, metolazone - hypokalemia, hypercalcemia, hyperuricemia, hyperlipidemia 3. K-sparing: Spironolactone - hyperkalemia (Esp with ACEi), gynecomastia
54
# [Cardiology/HF/Treatment] Both vasopressor and inotropic (3) Vasopressor (3) Inotropic (3)
Both vasopressor and inotropic - Epinephrine, Norepinephrine, Dopamine Vasopressor (3) - Vasopressin, Angiotensin, Phenylephrine Inotropic (3) - Milrinone, Isoproterenol, Dobutamine
55
# [Cardiology/HF/Treatment] Afterload reduction: Vasodilators (3)
1. ACEis 2. Sodium Nitroprusside 3. β-blocker
56
# [Cardiology/arrhythmia] Treatment for long QT syndrome
Mild: Propranolol Mod to severe: ICD (implantable cardioverter-defibrillator)

1. Pediatrics (22 decks)

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