Cardiology

Question 1

Which maternal condition can increase chances of the baby developing cardiac anomalies?

Answer 1

Diabetes

Question 2

Thin long fingers can be a sign of which syndrome?

Answer 2

Marfan’s syndrome

->also high arched palate

Question 3

In which heart disease may non-purulent conjunctivitis be seen?

Answer 3

Kawasaki heart disease

Question 4

Which heart problem is seen in children with William’s syndrome?

Answer 4

Supravalvular aortic stenosis

Question 5

What are some of the cardiac abnormalities seen in children with DiGeorge syndrome?

Answer 5

Interrupted aortic arch

Question 6

What are some of the cardiac abnormalities Turner syndrome has an association with?

Answer 6

Bicuspid aortic valve
Aortic coarctation

Question 7

Where may pace-makers been seen in younger infants and neonates?

Answer 7

Abdomen

Question 8

Which type of murmur are always pathological- systolic or diastolic?

Answer 8

Diastolic

Question 9

Features when describing a murmur?

Answer 9

Systolic or diastolic
Site
Loudness
Radiation
Character- harsh, blowing, high-pitched, low-pitched

Question 10

What are innocent murmurs?

Answer 10

Harmless sounds made by the heart

Common in infancy and childhood, disappear in adulthood

->one of the commonest reasons for cardiology referral

Question 11

When may an innocent murmur become more obvious?

Answer 11

Fever
Anaemia
Anxiety
Infections

Question 12

Characteristics of an innocent murmur?

Answer 12

Soft
Systolic, except venous hum with is a continuous murmur
Varies with posture
No thrill
Short duration
Child asymptomatic

Question 13

Which is the commonest innocent murmur heard in children?

Answer 13

Still’s murmur

->most common in school age children

Question 14

Where is Still’s murmur best heard?

Answer 14

Left lower sternal edge

Question 15

When is Still’s murmur more obvious?

Answer 15

Supine position

->decreased in standing, sitting, Valsalva

Question 16

Physiological pulmonary stenosis is common in newborns, and can last until 3-6 months of age.

Where is it best heard?

Answer 16

Left upper sternal edge

->will radiate to back

Question 17

What position can cervical venous hum be heard in?

Answer 17

Only sitting position

Question 18

Which age group is cervical venous hum most common in?

Answer 18

Young school age children

Question 19

Where is cervical venous hum heard?

Answer 19

Anterior neck to infraclavicular area
R>L

Question 20

In which age group would pulmonary flow murmurs be heard?

Answer 20

Older children and teenagers

->more common in those with thin chest walls

Question 21

Where is pulmonary flow murmur best heard?

Answer 21

Left upper sternal edge

Question 22

Carotid bruits can be heard in children and young adults. When is it louder?

Answer 22

Anxiety/asthma

Question 23

Moving on from innocent murmurs..

Mild pulmonary stenosis can be asymptomatic.
Moderate and severe pulmonary stenosis can cause which symptoms?

Answer 23

Exertional dyspnoea and fatigue

Question 24

Where is pulmonary stenosis heard and where does it radiate to?

Answer 24

Upper left sternal border
Radiates to back

->ejection systolic murmur

Question 25

Intervention is required in moderate and severe pulmonary stenosis. What is most commonly done?

Answer 25

Balloon valvoplasty

Question 26

What happens as a consequence to balloon valvoplasty?

Answer 26

Catheter put through femoral vein up to RA, RV and then through the pulmonary valve. This fixes stenosis but causes some pulmonary regurgitation. Pulmonary regurgitation is well tolerated.

Question 27

Aortic stenosis is also asymptomatic if mild. What symptoms can be experienced in moderate to severe aortic stenosis?

Answer 27

Reduced exercise tolerance Exertional chest pain Syncope

Question 28

Where is aortic stenosis best heard, and where does it radiate to?

Answer 28

Right upper sternal border Radiates to carotids

Question 29

Management of moderate-severe aortic stenosis?

Answer 29

Similarly, balloon valvoplasty can be attempted but is higher pressure environment so aortic regurgitation is common. ->aortic regurgitation is not tolerated as well as pulmonary regurgitation

Question 30

Does umbilical vein carry oxygenated or deoxygenated blood?

Answer 30

Oxygenated blood

Question 31

Name three aspects of the heart which are part of embryological development but close after birth.

Answer 31

Ductus arteriosus Foramen ovale Ductus venosus

Question 32

What is it called if the ductus arteriosus doesn't close after birth?

Answer 32

Patent ductus arteriosus

Question 33

Which infants is patent ductus arteriosus more common in?

Answer 33

Pre-term infants

Question 34

Treatment of patent ductus arteriosus?

Answer 34

Fluid restriction/diuretics Prostaglandin inhibitors Surgery

Question 35

What happens in coarctation of the arota?

Answer 35

Narrowing of a segment of the aorta

Question 36

Clinical presentation of coarctation of the aorta?

Answer 36

Weak or absent femoral pulses Radio-femoral delay (chronic co-arctation only) Systolic murmur- loudest on back Sudden deterioration and collapse ->femoral pulses are checked in first day baby checks

Question 37

Management of coarctation of the aorta?

Answer 37

Surgery Balloon aortoplasty

Question 38

What is one of the important features of cyanotic heart defects?

Answer 38

Central cyanosis- tongue/lips must be blue

Question 39

Fallot's tetralogy?

Answer 39

Combination of four congenital heart defects that affect infants and children

Question 40

When is full correction of Fallot's tetralogy done?

Answer 40

When infant is at 5kg body weight, around six months

Question 41

How does heart failure present in an infant?

Answer 41

Tachypnoea on feeding, panting with feeds. Suck-rest pattern, need to take breaks from feeding. Tachycardia Hepatomegaly Cardiomegaly, faltering growth ->peripheral oedema associated with adults, not babies

Question 42

If a baby has Down syndrome, which cardiac anomaly are they most likely to have?

Answer 42

AVSD

Question 43

Symptoms of coarctation of aorta in neonates?

Answer 43

Presents acutely unwell, severe metabolic acidosis

Question 44

Symptoms of coarctation of aorta in older children?

Answer 44

Hypertension ->congenital narrowing of descending aorta which increases afterload on heart

Question 45

Investigations if you suspect coarctation of the aorta?

Answer 45

CVS exam Check femoral pulses Check BP ECHO is diagnostic

Question 46

Okay just to check, which test is diagnostic of coartation of the aorta?

Answer 46

ECHO

Question 47

Four anomalies in Fallot's tetralogy?

Answer 47

Ventricular septal defect Overriding of aorta Right ventricular hypertrophy RVOT obstruction

Question 48

Investigations for Fallot's tetralogy?

Answer 48

Oxygen sats CXR ECHO

Question 49

Presentation of Fallot's tetralogy?

Answer 49

Cyanosis Faltering growth Old child-squatting

Question 50

Treatment of Fallot's tetralogy?

Answer 50

Corrective surgery around 6 months In few patients- BT shunt

Question 51

What is meant by transposition of the great arteries?

Answer 51

Pulmonary artery and aorta are swapped over. This means that blood flows to lungs and picks up oxygen but is pumped back to lungs rather than the rest of the body. ->pulmonary artery arises from LV Aorta arises from RV

Question 52

Presentation of transposition of the great arteries?

Answer 52

Cyanosis in the immediate neonatal period

Question 53

Investigations of transposition of the great arteries?

Answer 53

Saturations CXR ECHO

Question 54

Treatment of transposition of the great arteries?

Answer 54

Commence prostaglandins- keeps the duct open Corrective surgery- arterial switch