Cardiology

Question 1

Two examples of right to left shunt

Answer 1

Tetralogy of fallot

Transposition of the great arteries

Question 2

Four features of tetralogy of fallot

Answer 2

Overriding aorta
Large VSD
R ventricular outflow tract obstruction due to subpulmonary stenosis
R ventricular hypertrophy

Question 3

Baby with hypercyanotic spells, loud harsh ejection systolic murmur and a small heart on chest x ray

Answer 3

Tetralogy of fallot

Question 4

Life threatening cyanosis on day two of life, egg on side cardiac contour and loud single second heart sound

Answer 4

Transposition of the great arteries - presents when duct closes

Question 5

Cyanosis at birth progressing to heart failure within two weeks. No murmur heard but a superior axis on ECG

Answer 5

Complete atrioventricular septal defect - single 5 leaflet valve between atria and ventricles

Question 6

Three forms of outflow obstruction in an otherwise well child

Answer 6

Aortic stenosis
Pulmonary stenosis
Adult type coarctation of the aorta

Question 7

Initial management for transposition of the great arteries

Answer 7

Prostaglandin to maintain ductus

Question 8

Small volume pulses with a carotid thrill and an ejection systolic murmur radiating to the neck.

Answer 8

Aortic stenosis

Question 9

Ejection systolic murmur at the left sternal edge and an ejection click

Answer 9

Pulmonary stenosis

Question 10

An asymptomstic ejection systolic murmur with radiofemoral delay no noticeable rib notching on chest X-ray

Answer 10

Adult type coarctation of the aorta - v uncommon

Question 11

Three causes of outflow obstruction in the sick infant

Answer 11

Coarctation of the aorta
Interruption of the aortic arch
Hypoplastic left heart syndrome

Question 12

Definition of coarctation of the aorta

Answer 12

Arterial duct tissue encircles the aorta at the point of the duct insertion therefore when the duct closes the aorta constricts –> severe obstruction to the left ventricular outflow

Question 13

Acute circulatory collapse in a two day old neonate with absent femoral pulses and a severe metabolic acidosis

Answer 13

Coarctation of the aorta

Question 14

Absent thymus, hypocalcaemia and an interrupted aortic arch

Answer 14

Di George syndrome

Question 15

22q11.2 microdeletion

Answer 15

Di George syndrome

Question 16

Short PR interval and delta waves on ecg

Answer 16

Wolff-Parkinson white

Question 17

Narrow complex re entry tachycardia with heart rate of 250+

Answer 17

Supraventricular tachycardia

Question 18

Management of supraventricular tachycardia - HR 250+, narrow complex

Answer 18

Circulatory and respiratory support
Vagal stimulation - carotid sinus massage
I.v. Adenosine
Electrical cardio version if adenosine fails.

Question 19

Cause of congenital complete heart block

Answer 19

Anti ro and la antibodies

Question 20

Inheritance of long QT

Answer 20

Autosomal dominant

Question 21

Causes of syncope in a child

Answer 21

Neurogenic - vagal/prolonged standing 
Situational - cough/swallow
Orthostatic
Ischamic
Arrhythmic - heart block or supraventricular tachycardia

Question 22

Five features of rheumatic fever

Answer 22

Pancarditis - friction rub/tamponade
Polyarthritis - 80%
Sydenham chorea - 2 to 6 months later 
Erythema marginatum 
Subcutaneous nodules on extensor surfaces

Question 23

Treatment of infective endocarditis

Answer 23

High dose penicillin and aminoglycoside for six weeks iv

Question 24

Which children are at the highest risk of developing infective endocarditis

Answer 24

Those with turbulent blood flow i.e. VSD/coarctation

Question 25

Child with retinal infarcts, microscopic haematuria, unexplained anaemia and sustained fever

Answer 25

Infective endocarditis