Cardiology

Question 1

Notching of ribs of XRAY

Answer 1

Coarctation of Aorta

Question 2

Genes associated with long QT syndrome

Answer 2

KCNH2
KCNQ1
SCN5A

Question 3

Diagnosis of Long QT

Answer 3

QTC >480 miliseconds
T wave anormalities

Question 4

Romano Ward syndrome

Answer 4

most common type of long QT
associated with 6 ion channel, most likely affected: K channel
Autosomal Dominant
no associated hearing loss

Question 5

Jervell and Lange-Nielson syndrome

Answer 5

Autosomal Recessive
defect in K channel
associated hearing loss

Question 6

Causes of long QT

Answer 6

• genetic syndromes e.g. Jervell and Lange-Nielson and Romano-ward
  -new mutations
• electrolyte abnormalties - hypo K, hypo Ca
• hypothermia
• medications e.g. marclodie Abx (erythromycin/clarithromycin/azithromycin), antimalarial e.g. quinine, antipsychotics e.g. olanzapine, quetiapine
  -cocaine
• HIV
• MI

Question 7

Symptoms of Long QT

Answer 7

syncope
palpitations
chest pain
hearing loss - JLN syndrome

Question 8

Management of long QT

Answer 8

beta blockers - atenolol, propanolol
surgical - ICD reserved for high risk with very long QTc or previous VF arrest

Question 9

Third aortic arches form the

Answer 9

internal carotid artery

Question 10

right fourth aortic arch forms the

Answer 10

right subclavian

Question 11

Left fourth aortic arch forms the

Answer 11

aortic arch between left common carotid and terminus of ductus arteriosus

Question 12

sixth aortic arches form the

Answer 12

pulmonary vasculature
right: right patent artery
left: left patent artery and ductus arteriosus

Question 13

what conditions cause pulmonary HTN

Answer 13

• CLD
• large VSD
• PDA
• AVSD
• cardiomyopathy
• Transposition of the great arteries

Question 14

CXR: increased radiolucency of lung fields with reduced pulmonary vascular markings

Answer 14

• suggests reduced pulmonary blood flow

lesions that cause reduced pulmonary flow:
most commonly Tetralogy of fallot
other examples: pulmonary stenosis, pulmonary atrersia and tricuspid atresia

Question 15

Tetralogy of fallot

Answer 15

• pulmonary stenosis
• right ventricular hypertrophy
• overriding aorta
• VSD

development: displacement of the outflow tract septum

Question 16

what is Eisenmenger syndrome

Answer 16

development of pulmonary HTN due to an untreated congenital heart defect
patients with trisomy 21 more at risk due to their higher risk of pulmonary HTN

Question 17

initial management of Eisenmenger

Answer 17

sildenafil or endothelin receptor antagonist

Question 18

Acute SVT treatment

Answer 18

1. vagal manoeuvres
2. adenosine

Question 19

Lown Ganong Levine syndrome

Answer 19

accelerated conduction through AV node
short PR interval <120ms
normal QRS, no delta wave

Question 20

Kawasaki disease

Answer 20

• fever 5 days or more
  and
  4/5:
• bilateral non purulent conjunctivitis
• erythematous polymorphic rash
• strawberry tongue/ cracking or bleeding of lips
• extremity changes: erythematous, painful, oedematous hands and feet, peripheral desquamation
• cervical lymphadenopathy

Question 21

Most common cardiac post op complication

Answer 21

pericardial effusion

Question 22

JONES criteria for diagnosis of rheumatic fever

Answer 22

Joint involvement
O carditis
Nodules - subcutanesous
Erythema marginatum
Sydenhams chorea

Question 23

Management of rheumatic fever

Answer 23

10 day course of penicillin
continues long term as secondary prophylaxis

Question 24

features of congestive heart failure, trisomy 21, presenting at 3/12, ECG= Superior axis

Answer 24

AVSD due to superior axis

1/3 patients with trisomy 21 have AVSD

Question 25

6 hour old baby, increased WOB and raised serum lactate

Answer 25

total anomalous pulmonary venous drainage

may require surgery first day of life
4 pulmonary drains drain to a confluence instead of L atrium
they drain to a different place e.g. SVC, coronary sinus

Question 26

diagnosis of Rheumatic fever

Answer 26

Jones Criteria
- recent strep infection with 2 major or one major and 2 minor

Question 27

major criteria for rheumatic fever

Answer 27

carditis
polyarthritis
sydenhams chorea
erythema marginatum
subcutaneous nodules

Question 28

minor criteria for rheumatic fever

Answer 28

fever
arthralgia
raised ESR or CRP
prolonged PR interval
previous strep infection or episode of rheumatic fever

Question 29

most common cardiac manifestation in lymes disease

Answer 29

first degree heart block - type of AV conduction defect

Question 30

most common CHD in DS

Answer 30

AVSD

Question 31

ECG: upright T wave V1, right axis deviation and dominant S wave in V5 and V6

Answer 31

tetralogy of fallot

Question 32

which phase of the cardiac cycle is abnormal in long QT syndrome

Answer 32

repolarisation phase

Question 33

cardiac abnormalities associated with marfans

Answer 33

aortic root dilatation –> aortic regurgitation and increased risk of dissection
mitral valve prolapse

Question 34

coarctation of the aorta

Answer 34

ejection systolic murmur radiates to the back
HTN
ECG: L ventricular hypertrophy: Deep S wave in V1, tall R wave V6
rib notching on xray
start prostaglandin ASAP - duct dependent

Question 35

pulmonary stenosis

Answer 35

usually asymptomatic
ejection systolic murmur radiates to back
ejection click

Question 36

ASD

Answer 36

usually asymptomatic
split second heart sound
ejection systolic murmur
cardiac catheterisation at 3 if still present

Question 37

Transposition of the great arteries

Answer 37

present early, first few days of life
severe cyanosis
no murmur
second heart sound is single
heart failure due to acidosis

Question 38

hypoplastic left heart syndrome

Answer 38

collapse in first few days of life
no cyanosis
absent pulses