Cardiology

Question 1

Still’s murmur

Answer 1

age 2-7
MLSB
1-3 systolic
vibratory
louder supine and w/ exercise

Question 2

Pulmonic systolic murmur

Answer 2

any age
ULSB
1-2 EARLY systolic
blowing 
louder supine and w/ exercise

Question 3

Venous hum

Answer 3

any age
heard below clavicles
continuous, ONLY while sitting or standing

Question 4

Primum ASD

Answer 4

Lower septum
cleft in mitral valve may also exist, causing MR

Seen in Down syndrome

Question 5

Secundum ASD

Answer 5

MCC of ASD

middle part of septum

Question 6

Sinus Venosus ASD

Answer 6

high in septum near junction w/ SVC

R pulmonary veins may drain into RA

Question 7

Systolic ejection murmur at ULSB
fixed split S2
Diastolic rumble at LLSB

Answer 7

ASD

Look for RAD, RVH, increased PVM

Question 8

Holosystolic, high pitched murmur at LLSB

Diastolic rumble at apex

Answer 8

VSD, look for LVH, increased PVMs, and RVH

Question 9

Continuous murmur at ULSB

Answer 9

PDA

Question 10

Eject clic with systolic ejection murmur with radiation to URSB and apex

Answer 10

AS

LVH

Question 11

Eject click with systolic murmur at ULSB

Answer 11

PS

RVH

Question 12

Post-ductal coarction

Answer 12

presents in adolescence
Delayed and dampened femoral pulses
*Bicuspid or stenotic aortic valve may be present
bruit may be heard near the L scapula

Question 13

Tx for Coarc in neonate

Answer 13

End-to-end anastamosis-50% recurrence

Balloon angioplasty is TOC in recurrent coarc

Question 14

When do you tx AS?

Answer 14

CHF, chest pain or syncope, 50-70 mmHg gradient
TOC is Ballon valvuloplasty
Replacement 5-10yrs later

Question 15

Cyanotic newborn
Systolic ejection murmur at RUSB
decreased PVM
R aortic arch 
Upturned cardiac apex on CXR

Answer 15

TOF

Question 16

Cyanotic newborn
No murmur
Single S2
Small heart and narrow mediastinum

Answer 16

Transposition

Question 17

Cyanotic newborn
Single S2, no murmur
RAE, LAD, LVH
Small heart
decreased PVM

Answer 17

Tricuspid atresia w/o VSD

NEED TO KEEP PDA OPEN

Question 18

Cyanotic newborn
Pansystolic murmur at LLSB
RAE, LAD, LVH
Small heart
decreased PVM

Answer 18

Tricuspid atresia w/ VSD

Question 19

Tx for tricuspid atresia

Answer 19

1) Glenn Shunt= SVC–> R pulm aa
2) Fontan procedure= IVC–> pulm aa
* goal is to redirect systemic venous return into the pulmonary aa

Question 20

Infant w/ mild de-sat or mild cyanosis
Systolic ejection murmur
Single S2
Diastolic murmur at LLSB

Answer 20

Truncus arteriosus

Question 21

Cyanotic newborn
Ejection murmur along LSB
increase PBV
Enlarged heart 
"snowman appearance"

Answer 21

TAPVR

Degree of cyanosis depends on presence of PFO or AD that allows for shunting into the L heart

Question 22

MCC of pericarditis in children

Answer 22

Viral infection (Coxsackie, echo, adeno, EBV)

Question 23

Harsh, systolic ejection murmur that is worse with standing and valsalva

Answer 23

HOCM

Question 24

Tx for HOCM

Answer 24

B-blockers or CCBs
Muomectomy 
anti-arrythmics PRN for ventricular dysrhythmias 
Dual chamber pacing
NO SPORTS

Question 25

MC dysrythia in children

Answer 25

SVT (origin of accelerated HR above bifurcation of bundle of HIS) can be d/t re-entrant or anomalous pathways or WPW

Question 26

TX of SVT

Answer 26

1) Vagal maneuvers (valsalva), icepack to forehead, carotid massage
2) IV adenosine
3) Cardioversion if hemodynamically unstable
4) can use propranolol or digoxin chronically
5) Cath ablation

Question 27

Congenital 3rd degree heart block

Answer 27

seen in kids born to moms w/ SLE

Question 28

Tx for heart block

Answer 28

WHEN SYMPTOMATIC

is cardiac pacing

Question 29

Jervell-Lange-Nielsen syndrome

Answer 29

long QT syndrome
AR
w/ DEAFNESS

Question 30

Romano-Ward

Answer 30

Long QT syndrome
AD
w/o deafness