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Royal College Exam > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Inheritance of long QT syndrome

A

autosomal dominant!
homozygous = Jervell Lange-Neilson (assoc with sensorineural hearing loss)
heterozygous = Romano-Ward

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2
Q

Treatment of long QT

A

avoid exercise, beta-blockers

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3
Q

What is the axis on ECG of a child with an AVSD?

A

left-axis deviation

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4
Q

in what congenital heart disease would you see left axis deviation?

A

AVSD, small RV (tricuspid atresia), Noonan syndrome (no clear reason why…)

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5
Q

what are the signs on ECG of LV hypertrophy

A

Tall R waves in V6, deep S waves in V1

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6
Q

ECG signs of RV hypertrophy

A

Tall R waves in V1, deep S waves in V6, Q waves in V1, upright T waves in V1 (after day 5 of life - should be flipped until about age 9)

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7
Q

Palivizumab - what is it

A

monoclonal IgG antibody against RSV

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8
Q

recurrence rate of congenital heart disease

A

4% up to 10% (higher if left-sided)

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9
Q

Complications of Fontan

A

protein-losing enteropathy, plastic bronchitis

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10
Q

What cardiac patients need antibiotic prophylaxis?

A

those with a high risk lesion (Cyanotic, repaired with prosthetic material in last 6 months, persistent defects - leak) undergoing a high risk procedure (dental procedure, non-infected gut/GU procedure)

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11
Q

ECG findings - pericarditis

A

diffuse ST elevation, PR depression, T wave flattening eventually T wave inversion

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12
Q

Main cause of CHF - first week of life

A
  • obstructions! hypoplastic left heart (d3-5), severe aortic stenosis, coarctation (d7-10)
  • asphyxia
  • uncontrolled tachycardia (SVT >24hrs)
  • severe mitral/tricuspid regurgitation
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13
Q

Main cause of CHF - week 2-6 of life

A

Things that cause left to right shunting: VSD, AVSD, PDA

NOT ASD!

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14
Q

Main cause of CHF - older children

A

pump failure!

dilated cardiomyopathy, myocarditis, tachycardia

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15
Q

3 signs of CHF in infants

A

tachycardia, tachypnea, hepatomegaly

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16
Q

Risk of recurrence of congenital heart disease (isolated case) in sib?

A

2-3%

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17
Q

CHD in Turner syndrome (name 3)

A
  • coarctation of the aorta, bicuspid aortic valve, aortic stenosis
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18
Q

CHD in fetal alcohol syndrome (name 3)

A

VSD, ASD, TOF

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19
Q

CHD in VACTERL

A

ASD, VSD, PDA (65-85%)

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20
Q

CHD in Trisomy 13 (patau) - name > 3

A

PDA, VSD, ASD, valvular disease, coarctation of the aorta, complex defects

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21
Q

CHD in Trisomy 18

A

VSD, polyvalvular disease (~100%)

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22
Q

Duct dependent for pulmonary circulation CHD

A
  • pulmonary atresia, critical pulmonary stenosis, pulmonary atresia with intact septum, TOF
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23
Q

Duct dependent for systemic circulation CHD

A

Severe aortic stenosis, interrupted aortic arch, hypoplastic left heart syndrome

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24
Q

CHD - duct required for “mixing”

A

TGA

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25
Most common type of ASD? (primum, sinus venosus, secundum) and ECG finding
secondum, right anterior deviation on ECG
26
Most common congenital heart disease and CXR finding
VSD, 14-18% | CXR - increased pulmonary vasculature, cardiomegaly
27
Most common CHD in T21
AVSD
28
What is bicuspid aortic valve associated with?
5-8% also have coarcation
29
Noonan syndrome CHD (name 2)
pulmonary stenosis w/ dysplastic pulmonary valve, hypertrophic cardiomyopathy
30
Alagille syndrome CHD
peripheral pulmonary stenosis
31
Physical exam and CXR findings of coarctation of aorta
shock, hypertension, murmur, ejection click (assoc with bicuspid valve), weak/delayed femoral pulses, BP gradient (upper/lower extremities), rib notching on cxr (due to collateral vessels going to descending aorta)
32
AVSD ECG finding
Left-ward and superior axis on ECG
33
Auscultation of aortic stenosis
Systolic ejection murmur at right upper sternal border, ejection click
34
Tetralogy of Fallot
- VSD - overriding aorta - pulmonary stenosis - right ventricular hypertrophy
35
X-ray with "wall to wall" heart
tricuspid regurgitation
36
What CHD to think about with tricuspid regurgitation
Ebstein's anomaly!
37
Rhythm abnormalities with Ebsteins
WPW
38
Initial management of TGA
- prostaglandin to keep duct open, balloon atrial septostomy
39
3 types of CHD associated with 22q11
common arterial trunk, tetralogy, interrupted aortic arch
40
Complications of Fontan
- arrhythmias - cyanosis - protein losing enteropathy - plastic bronchitis - thromboembolism
41
TAPVD - clinical findings and x-ray
- cyanosis, respiratory distress | - xray: snowman (only in supracardiac), increased pulmonary vasculature (venous blood stuck in pulmonary circulation)
42
What CHD should you NOT use PGE in?
TAPVD - increases pulmonary blood flow
43
Medical management of TAPVD
NONE!
44
Features of innocent heart murmurs
soft (gr II or less), normal heart sounds, quiet precordium, along sternal border, varies with position
45
Diastolic murmur heard in...
aortic or pulmonary valve regurgitation, AV valve stenosis
46
Pathologic systolic ejection murmur heard in...
aortic/pulmonic valve stenosis, ASD, coarctation
47
pansystolic murmur
VSD, AVVR (mitral, tricuspid)
48
continuous murmur
runoff lesions (PDA, AVM, aortopulmonary collaterals, BT shunt)
49
carditis of rheumatic fever
endomyocarditis with valvulitis involving the MITRAL and aortic valves
50
management of rheumatic fever associated carditis
mild = ASA, severe = prednisone
51
secondary prevention of rheumatic fever
- Pen G IM Q3-4wks - Pen V PO 250 mg BID if no carditis - 5 yrs or 21 yrs old (whichever is longest) if carditis - 10 yrs or 25 yrs of age if carditis with valve involvement - at least 40 yrs or life-long
52
clinical features of pericarditis
sharp, stabbing precordial pain; worse when supine, better leaning forward (pain = referred from diaphragm/pleura); friction rub on auscultation; ECG = diffuse ST elevation
53
Cardiac findings in Pompe disease
- hypertrophic cardiomyopathy, increased wall thickness, supraventricular tachycardia, short PR interval, very high QRS voltages
54
What is Jervell and Lange-Nielsen syndrome?
Long QT + sensorineural deafness, autosomal recessive (homozygous)
55
Unexplained nocturnal death in a structurally normal heart - what syndrome?
Brugada syndrome
56
Leading cause of acquired heart disease in childhood
Kawasaki disease
57
Greatest risk of developing aneurysms in KD
- male gender - young age (<6mos) - not treated with IVIG
58
Emergency treatment of VT
synchronized cardioversion, IV lidocaine, IV amiodarone, correct underlying etiology, others - procainamide, magnesium
59
Definition of pulmonary hypertension
mean pulmonary arterial pressure > 25 mmHg at rest
60
ECG change in acute rheumatic fever
prolonged PR
61
A/E of adenosine
atrial fibrillation
62
A/E of PGE1
apnea hypotension fever edema

Royal College Exam (32 decks)

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