Cardiology

Question 1

In utero, this structure allows 50% of umbilical venous blood to go directly to the IVC, bypassing the liver

Answer 1

Ductus venosus

Question 2

Pulmonary vascular obstructive disease usually seen in VSDs that may cause pulmonary hypertension

Answer 2

Eisenmenger’s syndrome

Question 3

In fetal transitional circulation, after birth, the interruption of blood supply of umbilical cord results in:

Answer 3

1) increase in SVR (due to removal of placenta)

2) closure of ductus venosus (due to cut blood supply from placenta)

Question 4

In fetal circulation, less oxygenated blood from the pulmonary artery flows through this structure that opens directly to the descending aorta and then to the placenta for oxygenation

Answer 4

Ductus arteriosus

Question 7

Acyanotic infant with systolic ejection murmur at 2nd left ICS with widely split S2; on PE, right-sided enlargement; leads to CHF and Pulmonary hypertension if left untreated

Answer 7

Atrial septal defect (Ostium Secundum type most common)

Question 8

In fetuses, around 1/3 of blood from fetal Inferior Vena Cava is directed to the left atrium directly via this structure:

Answer 8

Foramen Ovale (other 2/3 enters right ventricle then pulmonary artery)

Question 9

Acyanotic infant with systolic regurgitant murmur at the left lower sternal border with loud S2 heard (unsplit); left-sided enlargement with biventricular hypertrophy if with Eisenmenger’s Syndrome (pulmonary vascular obstructive disease); this defect may usually present with recurrent pulmonary infections and delayed growth and development

Answer 9

Ventricular Septal Defect (most common congenital heart disease)

Question 9

Acyanotic infant with a continuous “machinery-like” murmur heard at the 2nd left infraclavicular area; on PE, patient has hyperactive precordium, bounding pulses with wide pulse pressure.

Answer 9

Patent Ductus Arteriosus (patency between left pulmonary artery and descending aorta)

Question 10

Most common cause of cyanotic congenital heart disease in newborns; patient has single, loud S2 with hypoxemia unresponsive to oxygen inhalation; on CXR, an egg-shaped cardiac silhouette with a narrow, superior mediastinum.

Answer 10

Transposition of the Great Arteries (aorta arises from right ventricle, pulmonary artery arises from left ventricle)

Question 10

Cyanotic condition in infant with pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect and the aorta overriding this defect; patient may present with a systolic ejection murmur at 2nd upper left sternal border. On CXR, boot-shaped heart seen.

Hypoxic spells (paroxysm of hyperpnea, irritability, prolonged crying, increasing cyanosis, decreasing intensity of murmur after crying, feeding or defecation)

Answer 10

Tetralogy of Fallot

Question 10

Palliative surgical management of Tranposition of Great Arteries wherein the objective is to create an interatrial communication to avoid progressive hypoxemia

Answer 10

Balloon atrial septostomy (Rashkind procedure) and surgical atrial septostomy (Blalock-Hanlon procedure)

Question 11

Definitive surgical repair for TGA wherein objective is to switch right and left-sided blood

Answer 11

1) Atrial level repair (Senning or Mustard)
2) Ventricular level repair (Rastelli)
3) Great Artery level repair (Jatene)

Question 12

General management of hypoxic spells in TOF:

Answer 12

1) Knee-chest position (decrease systemic venous return from legs)
2) Morphine sulfate (suppress respiratory center)
3) NaHCO3
4) Oxygen (improve arterial oxygenation)
5) Phenylephrine (raise SVR)
6) Propranolol (stabilize vascular reactivity of systemic arteries to prevent drops in SVR)
7) Ketamine (raise SVR)

Question 13

Surgical management options for Tetralogy of Fallot:

Answer 13

Bloalock-Taussig (for >3 months old) and Gore-Tex Shunt (for

Question 14

What are the components of Tricuspid Atresia?

Answer 14

1) Atretic tricuspid valve (missing valve)
2) Hypoplastic Right Ventricle
3) Ventricular Septal Defect
4) Atrial Septal Defect
5) Pulmonary Stenosis

Question 15

Management of patient with Tricuspid Atresia with severe cyanosis?

Answer 15

Blalock-Taussig Procedure

Question 16

Management of 4-8month old patient with Tricuspid Atresia?

Answer 16

Bidirectional Glenn shunt (anastomosis of SVC and pulmonary arteries to reduce volume load of LV)

Question 17

Management of 1.5-3 year old patient with Tricuspid Atresia?

Answer 17

Modified Fontan Operation

Question 18

Cyanotic condition where in the pulmonary arteries arise from the aorta with the presence of a stenotic quadracuspid truncal valve and the presence of a large ventral septal defect

Answer 18

Truncus Arteriosus

Question 19

All four pulmonary veins connect to the superior vena cava thus increased volume is drained back to the right atrium causing right ventricle overload. On CXR, snowman sign is seen.

Answer 19

Total anomalous pulmonary venous return

Question 20

A 5 year old child came in with weak femoral pulses. On BP taking of extremities, measurements were higher on the upper extremities than the lower ones. On CXR, rib notching was seen.

Answer 20

Coarctation of the Aorta

Question 22

What specific part of the aorta is usually affected in Coarctation of Aorta?

Answer 22

Descending aorta, distal to the origin of the left subclavian artery

Question 23

An obstructive condition wherein it is asymptomatic unless severe and on auscultation, a systolic ejection murmur is heard at the left upper sternal border with radiation to the back

Answer 23

Pulmonary Stenosis

Question 24

PE findings of a harsh systolic ejection murmur at the right upper sternal border with occasional systolic thrill at the suprasternal notch. This condition is usually implicated in syncope and sudden death occuring during exertional activity (ex. Exercise)

Answer 24

Aortic stenosis

Question 25

What chromosomal abnormality is typically associated with Coarctation of Aorta?

Answer 25

Turner’s Syndrome (45, XO)

Question 26

Aschoff bodies in the myocardium are seen in?

Answer 26

Rheumatic Fever

Question 27

Valvular damage in RHD usually affects these following valves (in order of incidence):

Answer 27

Mitral valve > aortic valve > tricuspid valve > pulmonary valve

Question 28

The major manifestations in Jones Criteria include:

Answer 28

Mnemonic: JONES

1) Joint inflammation (Arthritis)
2) “Oh, my heart” (Carditis)
3) Nodules (Subcutaneous)
4) Erythema Marginatum
5) Sydenham’s Chorea

Question 29

Diagnostic used in Rheumatic Fever to increase probability of diagnosis on top of the usage of Jones Criteria:

Answer 29

Antistreptolysin Titer (ASO)

Remember the 2-4-6-8 ASO rule:
Elevated after 2 weeks (post-infection)
Peaks after 4-6 weeks
Declines after 8 weeks

Question 30

Choice of antibiotics to eradicate Streptococcus:

Answer 30

Penicillin
Benzathine
Eryhtromycin

Question 31

Anti-inflammatory agent used in treating Rheumatic fever with MILD carditis:

Answer 31

Aspirin

Question 32

Anti-inflammatory agent used in treating Rheumatic fever with SEVERE carditis:

Answer 32

Prednisone

Question 33

Most common valvular involvement in adults with valvular heart diseae

Answer 33

Mitral stenosis

Question 34

Most common valvular involvement in children with Valvular heart disease and Rheumatic Heart Disease

Answer 34

Mitral Regurgitation

Question 35

Most common valvular heart disease regardless of age and gender. Usually associated with connective tissue disorders such as Marfan’s syndrome and Ehler-Danlos syndrome.

Answer 35

Mitral Valve Prolapse