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Pediatric Questions > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

1
Q

Newborn with cyanosis, pulse oximetry changed
from 60% to 64% only on 100% oxygen

A

Cardiac (most likely)

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2
Q

Newborn with cyanosis, pulse oximetry changed
from 60% to 88% on 100% O2

A

Pulmonary (most likely)

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3
Q

What is the reason that left to right shunt lesions may not present until 1 month of age?

A

The pulmonary vascular resistance drops to
normal levels at that time

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4
Q

A 1-day-old infant with a history of maternal
diabetes, cyanosis, and tachypnea, poor response to supplemental oxygen, loud single second heart sound, no murmur, chest radiograph shows narrow mediastinum with small heart tipped on side, increased pulmonary vascularity

A

Transposition of great vessels

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5
Q

What is the next best step in a newborn with
suspected transposition of the great vessels?

A

Prostaglandin E1 to keep the patent ductus
arteriosus (PDA) open, followed by +/− balloon
atrial septostomy and surgery

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6
Q

The most common cause of cyanotic heart disease presenting a few days after birth

A

Transposition of the great vessels

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7
Q

Newborn presents with cyanosis in the lower
extremities, tachycardia, respiratory distress, and loud single S2 sound

A

Persistent pulmonary hypertension (R→L
shunting across the PDA)

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8
Q

A 1-day-old newborn presents with cyanosis,
single first and second heart sounds, chest
radiograph, shows decreased lung markings, and electrocardiogram shows left axis deviation

A

Tricuspid atresia with pulmonary atresia

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9
Q

Newborn presents with cyanosis (mother was on a medicine for severe bipolar disorder), chest radiograph shows cardiomegaly and right atrial enlargement

A

Ebstein anomaly

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10
Q

Newborn presents with severe cyanosis, systolic
ejection murmur, and a single second heart sound, chest radiograph shows decreased pulmonary vascular markings

A

Severe pulmonary stenosis

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11
Q

Newborn presents with intense cyanosis and
respiratory distress, chest radiograph shows a
“snowman” shaped heart

A

Supracardiac total anomalous pulmonary venous return

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12
Q

An 8-week-old boy presents with feeding
difficulties, poor weight gain, episodes of bluish
discoloration of the skin while feeding and crying, a harsh systolic ejection murmur (SEM) is heard over the pulmonic area and left sternal border; chest radiograph shows diminished vascularity in the lungs and diminished prominence of the pulmonary arteries, a boot-shaped heart (coeur en sabot)

A

Tetralogy of Fallot

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13
Q

During the first 48 h of life, a newborn rapidly
develops cyanosis, tachypnea, respiratory distress, pallor, lethargy, metabolic acidosis, oliguria, weak pulses in all extremities, hepatosplenomegaly, and no murmur

A

Hypoplastic left heart (as PDA closes)

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13
Q

A 2-year-old with a history of tetralogy of Fallot
has progressive agitation, increasing cyanosis, and increased fussiness

A

Hypercyanotic spell (Tet spell)—next step is the
knee-chest position

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14
Q

What is the next best step for the newborn in the previous case with suspected hypoplastic left heart?

A

Prostaglandin E1

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15
Q

A 2-week-old boy develops congestive heart
failure, severe metabolic acidosis, and poor
perfusion of the lower extremities

A

Coarctation of the aorta

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16
Q

Newborn presents with shock; the echocardiogram shows coarctation of the aorta. What is the drug of choice?

A

Prostaglandin E1

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17
Q

A 12-year-old presents with hypertension,
occasional headache, leg cramps, weak and
delayed femoral pulse, and blood pressure in the upper limb is higher than the lower limb, chest radiograph shows rib notching and scalloping on the undersurface of posterior ribs

A

Coarctation of the aorta

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18
Q

Newborn presents with shock; the echocardiogram shows coarctation of the aorta. What is the drug of choice?

A

Prostaglandin E1

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18
Q

A 12-year-old presents with hypertension,
occasional headache, leg cramps, weak and
delayed femoral pulse, and blood pressure in the upper limb is higher than the lower limb, chest radiograph shows rib notching and scalloping on the undersurface of posterior ribs

A

Coarctation of the aorta

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19
Q

A girl with Turner syndrome presents with
hypertension, weak and delayed femoral pulse

A

Coarctation of the aorta

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20
Q

Newborn infant presents with a soft, harsh systolic ejection murmur, best heard at the axillae, and precordium and no symptoms

A

Peripheral pulmonary stenosis (PPS)

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21
Q

Newborn infant presents with a soft, harsh systolic ejection murmur, best heard at the axillae, and precordium and no symptoms

A

Peripheral pulmonary stenosis (PPS)

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21
Q

The most common cardiac lesion associated with trisomy 21 (Down syndrome)

A

Endocardial cushion defect O. I. Naga

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22
Q

The most common cardiac lesion associated with Turner syndrome

A

Bicuspid aortic valve

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23
Q

The most common cardiac lesion associated with trisomy 18

A

Ventricular septal defect (VSD)

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24
Q

The most common cardiac lesion associated with Williams syndrome

A

Supravalvar aortic stenosis

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25
Q

The most common cardiac lesion associated with Noonan syndrome

A

Pulmonary stenosis

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26
Q

The most common cardiac lesion associated with DiGeorge syndrome

A

Tetralogy of Fallot

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26
Q

The most common cardiac lesion associated with Alagille syndrome

A

Branch pulmonary stenosis

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27
Q

The most common cardiac lesion associated with cri du chat syndrome

A

VSD

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28
Q

The most common cardiac lesion associated with Holt–Oram syndrome

A

Atrial septal defect (ASD)

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29
Q

The most common cardiac lesion in fetal alcohol
syndrome

A

VSD, ASD

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30
Q

The most common cardiac lesion associated with lithium teratogen

A

Ebstein anomaly

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31
Q

The most common cardiac lesion associated with supraventricular tachycardia

A

Ebstein anomaly

32
Q

The most common cardiac lesion associated with the infant of a diabetic mother

A

Ventricular hypertrophy

33
Q

The most common cardiac lesion associated with tuberous sclerosis

A

Cardiac rhabdomyoma

34
Q

The most common valvular lesion associated with acute rheumatic fever

A

Mitral regurgitation

35
Q

The most common cardiac lesion associated with Marfan syndrome

A

Aortic root dilation (risk for dissection)

36
Q

The most common congenital cardiac lesion
overall

A

VSD

37
Q

The syndrome that is associated with true
interrupted aortic arch

A

DiGeorge syndrome

37
Q

Adolescent routine physical exam, apical midsystolic non-ejection click, and late systolic
murmur; the murmur is louder when goes from a supine to a standing position, and the murmur becomes softer when squatting

A

Mitral valve prolapse

38
Q

Child routine physical exam, systolic murmur with a vibratory character, best heard in the lower sternal border, varies with changes in respiration and position

A

Still’s murmur

39
Q

A 6-year-old with a continuous murmur, lowpitched sound, best heard in the infraclavicular region, disappears when supine and with gentle pressure on the jugular vein

A

Venous hum

40
Q

While having her hair brushed, a 15-year-old girl
develops cold sweats, pallor, and palpitations and loses consciousness for 10 s

A

Vasovagal syncope

41
Q

While running, a 15-year-old girl lost
consciousness

A

Thorough cardiac evaluation and referral to a
cardiologist

42
Q

The most common cause of sudden cardiac death in an athlete

A

Hypertrophic cardiomyopathy

42
Q

Newborn fails hearing screen; EKG shows a very
prolonged QT interval

A

Jervell and Lange-Nielsen syndrome

42
Q

A 5-year-old, heart rate is 230 beats/min, chest
discomfort; the heart rate decreases to 80 beats/ min after ice is applied to the face

A

Supraventricular tachycardia (SVT)

42
Q

A 15-year-old girl faints while running and has a
positive family history of deafness and sudden
death

A

Long QT syndrome

43
Q

What is the definitive treatment for SVT?

A

Radiofrequency ablation

44
Q

Child presents with a history of intermittent
tachycardia; EKG shows a short PR interval,
slurred and slow rise of the initial upstroke of QRS (delta wave), widened QRS complex

A

Wolff–Parkinson–White syndrome (WPW)

45
Q

Child presents with chest pain, fever, friction rub; EKG shows diffuse ST-segment elevation, had upper respiratory infection 10 days before

A

Pericarditis

46
Q

Adolescent diagnosed with influenza presents with fever, tachycardia, edema, and gallop; chest radiograph shows pulmonary edema, cardiomegaly, low-voltage EKG

A

Myocarditis

47
Q

An athlete presents with dyspnea while playing;
systolic ejection crescendo-decrescendo murmur best heard at the apex and left sternal border, and radiates to the suprasternal notch; the murmur is louder while standing and with Valsalva maneuver

A

Hypertrophic cardiomyopathy

48
Q

A football player presents with chest pain with
exertion and several near syncope episodes during his football game. Next best step?

A

Restrict from sports then EKG and
echocardiogram

49
Q

EKG in a 12-day-old shows negative T wave in V6

A

Left ventricular hypertrophy

50
Q

A 15-year-old boy with a history of recurrent chest pain during exercise faints and dies while playing basketball; hypertrophic cardiomyopathy ruled out as a cause of death. What is the next likely cause?

A

Anomalous left coronary artery is most likely

51
Q

What is the most common organism responsible for infective endocarditis in pediatric patients with or without congenital heart disease?

A

Staphylococcus aureus

52
Q

History of repaired VSD with a small residual VSD next to the VSD patch, going in for dental work. Is subacute bacterial endocarditis (SBE) prophylaxis indicated?

A

Antibiotic prophylaxis

53
Q

Child with prosthetic mitral valve going for
surgery; is SBE prophylaxis indicated?

A

Antibiotic prophylaxis

54
Q

Child with mitral regurgitation and VSD, going in
for dental work. Is SBE prophylaxis indicated?

A

No antibiotic prophylaxis

55
Q

Child with a previous history of endocarditis; is
SBE prophylaxis indicated?

A

Antibiotic prophylaxis

56
Q

A mildly desaturated child with tetralogy of Fallot going in for dental work; is SBE prophylaxis indicated?

A

Antibiotic prophylaxis

57
Q

Tall, peaked T waves in precordial leads indicates

A

Hyperkalemia

58
Q

An infant of diabetic mother presents a few hours after birth with jitteriness, hypoglycemia, cyanosis; EKG shows prolonged QT interval

A

Hypocalcemia

59
Q

EKG shows sinus tachycardia, widened QRS
complex with an interval greater than 100 ms, in a child who presents with altered mental status after accidentally ingesting grandmother’s medication

A

Tricyclic antidepressant (TCA) toxicity

60
Q

EKG shows normal PR intervals and periodic drop in QRS

A

Type II second degree AV block (Mobitz II)

60
Q

EKG shows progressive prolongation of PR
interval followed by a drop in QRS

A

Type I second degree AV block (Mobitz I or
Wenckebach)

61
Q

A 6-month-old infant with failure to thrive,
diaphoresis, and hepatomegaly. Echocardiogram shows a large VSD. Next best step?

A

Surgical correction

61
Q

An asymptomatic adolescent with blood pressure 137/87, all labs normal, renal US and chest radiograph normal. What is the next best step?

A

Salt restriction in diet

62
Q

A late complication of an untreated ASD or VSD
that results in desaturation

A

Eisenmenger syndrome—shunt becomes a right
to left shunt

63
Q

A 4-year-old boy with physical examination
significant for widely split and fixed S2 and
crescendo-decrescendo systolic ejection murmur heard in the second intercostal space at the upper left sternal border. EKG shows a RSR1 pattern in V1. What is the most likely diagnosis?

A

Atrial septal defect

64
Q

A premature infant with a continuous machine-like murmur and bounding pulses

A

PDA

65
Q

Which medication is used to close a PDA in a
premature infant?

A

Indomethacin

66
Q

What are some common side effects of
indomethacin?

A

Thrombocytopenia
GI bleeding
Necrotizing enterocolitis
Renal failure

67
Q

Systolic murmur most commonly heard at the right upper sternal border radiates to the neck and is associated with an ejection click

A

Aortic stenosis

67
Q

Most common valve abnormality associated with aortic stenosis

A

Bicuspid aortic valve

68
Q

What is the most likely etiology of an early highpitched diastolic murmur associated with bounding pulses in a patient with Marfan syndrome?

A

Aortic regurgitation

69
Q

High-pitched holosystolic blowing murmur heard loudest at the apex and radiates to the axilla

A

Mitral valve regurgitation

70
Q

What is the most feared complication of Kawasaki disease?

A

Coronary artery aneurysm

70
Q

Late crescendo systolic murmur associated with a mid-systolic click, may be seen in adolescents

A

Mitral valve prolapse

70
Q

Late diastolic rumbling murmur with an opening
snap heard at the apex

A

Mitral valve stenosis

71
Q

A 10-year-old male presents with sharp chest pain; the pain is reproducible on physical exam

A

Costochondritis

71
Q

An 8-year-old presents with sharp stabbing nonspecific chest pain at rest that resolves shortly. There are no other symptoms and no past medical history

A

Reassurance (precordial catch syndrome)

72
Q

At what ages is lipid screening universally
recommended in the pediatric population?

A

Once between 9 and 11 and again between 17
and 21

73
Q

What is the initial management for an obese
adolescent with elevated cholesterol levels?

A

Diet and lifestyle modifications, and if
cholesterol is still elevated after 6 months, then
start statin

Pediatric Questions (31 decks)

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