Cardiology

Question 1

Child presented with heaves on examination, Ecg shows RBBB On ECHO: right ventricle motion abnormality and right ventricle hypertrophy What is the most likely cause?

A. Mitral prolapse

B. ASD

C. VSD

D. Coarctation of aorta

Answer 1

Answer: D

Not enough clues but this looks like coarctation of the aorta because of the right ventricular hypertrophy and the fact that septal defect was not seen on echo.

Question 2

11 years old patient with rheumatic fever and cardiac involvement. For how long he will require prophylaxis?

A. 5 years

B. 6 years

C. 10 years

D. 15 years

Answer 2

Answer: d or c

➢ Depends on uptodate the answer is c see the pic.

Question 3

Which of the following congenital heart disease is the least associated with infective endocarditis?

A. Asd

B. Vsd

C. Pda

D. Pulmonary stenosis

Answer 3

Answer: a

➢ Valvular aortic stenosis – 13.3 percent

➢ Coarctation of the aorta – 3.5 percent

➢ Primum atrial septal defect –2.8 percent

➢ Ventricular septal defect (vsd) –2.7 percent

➢ Tetralogy of fallot (tof) –1.7 percent

➢ No child with secundum atrial septal defect, patent ductus arteriosus (pda), or pulmonic stenosis had ie after surgery.

The commonest congenital lesions involved in infective endocarditis are those with a VSD, or Aortic disease

Question 4

( long scenario) child have 1mm defect in muscular atrial septum. What you will do? A. Surgical repair.

B. Catheter repair.

C. Reduce after load.

D. Watchful waiting.

Answer 4

Answer: d

80-100% spontaneous closure rate if asd diameter <8 mm

Question 5

About cyanotic heart disease.

A. Tof

B. Asd

C. Vsd

D. Pda

Answer 5

Answer: a

Question 6

Which syndrome is associated with coarctation of the aorta :

A. Down syndrome. (50% atrioventricular septal defect )

B. Patau syndrome. ( 80% with vsd , pda , asd )

C. Edward syndrome ( 60% with vsd , pda , asd )

D. Turner syndrome.

Answer 6

Answer: d

Turner syndrome is associated with the following :

*congenital heart defect particularly coarctation of aorta , bicuspid aortic valve

*hypothyroidism

*renal anomalies

Question 7

Which of the following is a cyanotic heart disease?

A. Asd

B. Vsd

C. Pda

D. Truncus arteriosus

Answer 7

Answer: d

Question 8

12 y.old girl htn:

A. 120/80

B. 40/99

C. Above 90 percentile

D. Above 95 percentile

Answer 8

Answer: D

Hypertension in pediatrics is based on the nomogram and falls into 4 categories:

·Normal: ≤ 90 percent

·Pre-hypertension: > 90 to ≤ 95 percent

·Stage I: > 95 to ≤ 99 percent

· Stage II: ≥ 99 percent + BP 5 mm Hg

Routine blood pressure checks are recommended beginning at age 3

On exam, be sure to check all 4 extremities (to look for coarctation).

Consider renal causes of hypertension in every pediatric patient presenting with hypertension.

Diagnostic Testing

·Screening tests:-CBC-Urinalysis-Urine culture-Electrolytes-Glucose-BUN-Creatinine-Calcium-Uric acid-Lipid panel with essential hypertension and positive family history

·Echocardiogram for chronicity (left ventricular hypertrophy)

·Kidney evaluation: -Renal ultrasound

• Voiding cystourethrogram, if there is a history of repeated UTIs (especially < 5 years)
• 24-hour urine collection for protein excretion and creatinine clearance
• Plasma renin activity (PRA): Best screen for renovascular and renal disorders

·Endocrine causes: -Urine and serum catecholamines, if pheochromocytoma is suspected

-Thyroid and adrenal hormone levels

· Drug screening (in adolescents), if drug abuse is suspected

Treatment

If the patient is obese, order lifestyle changes: ·Weight control ·Aerobic exercise ·No-added-salt diet

· Monitoring of blood pressure If there is no response to lifestyle changes, give antihypertensives: ·The best initial antihypertensive is a diuretic or beta blocker. · Then add calcium channel blocker and ACE inhibitor (good in high-renin hypertension secondary to renovascular or renal disease or high-renin essential hypertension)

Question 9

Which of the following congenital heart disease is secondary to failure of spiral rotation of the heart septum?

A. Transposition of great artery

B. Asd

C. Vsd

D. Pda

Answer 9

Answer: a

Misalignment of the sepatum can cause the congenital heart conditions tetralogy of fallot, persistent truncus arteriosus, dextro-transposition of the great arteries, tricuspid atresia, and anomalous pulmonary venous connection

Question 10

10 years old child with Rheumatic heart without cardic involvement , pptx for how long?

A. 3m

B. 6m

C. 6 yrs

D. 10 yrs

Answer 10

Answer : D ?

Question 11

Which of the following is the most common heart abnormality to get infective endocarditis?

Answer 11

Tetralogy of fallot

In children, cyanotic heart disease is still the most common cause of endocarditis, and the risk does not diminish after surgical repair as prostheses carry their own risk.

Bacterial endocarditis is most common in aortic valve lesions, a patent ductus arteriosus (unrepaired), tetralogy of Fallot, ventricular septal defects, coarctation of the aorta, and mitral valve prolapse with mitral regurgitation.

Question 12

Tetralogy of fallot findings ?

Answer 12

Ventricular Septal Defect (VSD) + Overriding of the aorta + Pulmonary Stenosis + Right Ventricular Hypertrophy (RVH)

●The pathophysiologic effects of TOF are largely dependent upon the degree of: RV outflow obstruction. murmur,

●The clinical presentation :, intermittent hypercyanotic (tet) spells, crescendo-decrescendo harsh systolic ejection and a single second heart sound.

●The diagnosis of TOF is typically made by echocardiography, which can usually delineate the location and number of VSDs, the anatomy and severity of RV outflow tract obstruction, the coronary artery and aortic arch anatomy, the presence of any associated anomalies, and the hemodynamic abnormalities associated with the anatomical defects.

●Treatment is by surgical repair. This usually consists of complete intracardiac repair typically during the neonatal or infant period. Occasionally, an aortopulmonary shunt is used palliatively before complete repair. RV failure, The most common long-term complications of complete repair are progressive pulmonary regurgitation and atrial arrhythmias, and ventricular arrhythmias.

Question 13

case of TOF. How does it appear on X-Ray and echo?

Answer 13

ECG: RAD, RVH

CXR: boot shaped heart, decreased pulmonary vasculature, right aortic arch (in 20%)

Echo : 1- the location and number of VSD

2- the anatomy and severity of RT ventricular outflow tract obstruction

3- the coronary artery and aortic arch anatomy

4- the presence of any associated anomaly

Question 14

Atrial septal defect (ASD) there will be ?

Answer 14

Answer: fixed S2 split

Question 15

Rheumatic fever prophylaxis?

Answer 15

answer: IM penicillin monthly

An injection of 0.6-1.2 million units of benzathine penicillin G intramuscularly every 4 weeks is the recommended regimen for secondary prophylaxis for most US patients. Administer the same dosage every 3 weeks in areas where rheumatic fever is endemic, in patients with residual carditis, and in high-risk patients.

Question 16

7 month baby with you discover that the baby has VSD and Asymptomatic otherwise healthy what are you going to do?

A. Close observation

b. Surgery

C. F/u after 6 month

Answer 16

Answer: f/u after 6 months

• No intervention is usually required for patients with small defects. These patients are typically asymptomatic and have a reasonable expectation of spontaneous closure or decrease in the size of the defect over time.
• Patients who continue to have a murmur, but are otherwise asymptomatic and growing well at the 8- to 10-week visit, are seen again by the pediatric cardiologist at approximately 12 months of age.
• If the murmur persists at the 12-month and the patient remains asymptomatic and clinically stable, no further intervention is required. Echo follow-up is typically performed at three years of age for patients with membranous defects. In those with a muscular defect, no echo is required if the patient remains asymptomatic.
• Asymptomatic patients with residual small defects are usually followed every two to five years for overall assessment.

Question 17

2Q about clinical finding of coarctation of Aorta (straight forward)

Answer 17

Coarctation of aorta:

1- radio femoral delay .. there is an absent or delayed femoral pulse (when compared with the brachial pulse).

2- Baby with Deference in the Bp in upper and lower Extremities

if there’s a murmur may be associated with other cardiac defects, such as PDA, aortic stenosis, or ventricular septal defect (VSD).

Question 18

Which one of these disease likely to exhabit cynosis in later life ?

A. 6 year with coartcation of aorta

B. VSD

C. Trancus arteriosis

D. ASD

Answer 18

May be VSD ( esinmenger syndrmoe )