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Pediatric Rotation > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Is ASD a R –> L shunt or a L –> R shunt?

A

It is a Left to Right shunt

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2
Q

What is the most common congenital anomaly in adults?

A

ASD

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3
Q

T or F: Most ASDs will close in childhood

A

True

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4
Q

Which of the following is least true about ASDs:

  1. It is a cyanotic shunt
  2. The most common location for an ASD is the osmium secundum
  3. Pulmonary pressures are modestly elevated in ASD
  4. Only about 15% of ASDs go into Eisenmenger Syndrome
A
  1. Is it an Acyanotic Left to Right shunt unless VERY huge causing Eisenmenger Syndrome
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5
Q

A 13 y/o male is complaining he cannot run as much as he used to during track practice. He also complains thatHIS chest feels like it thumping a lot lately. On PE, you hear a fixed split of S2 and a systolic murmur at the ULSB. You also hear a diastolic murmur at the LLSB. You order a CXR, EKG, an Echo and refer to pediatric cardiology. While awaiting for the test results–what is your leading diagnosis of this patient?

A

ASD

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6
Q

What is the proper treatment for a patient with ASD?

A
  1. Surgical closure

2. Percutaneous closure

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7
Q

What is the triad of sxs older children and adolescents often present with when they have ASD?

A
  1. Decreased stamina
  2. Palpitations
  3. Blood clots
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8
Q

Which of the following is most true about Coarctation of the aorta?

  1. It is a Cyanotic lesion of the heart
  2. 2% are Preductal
  3. 50% are Postductal
  4. Very common finding in Trisomy 21 patients
A
  1. It is an Acyanotic lesion of the heart.
  2. YES; 2% are Preductal lesions
  3. 98% are Postductal lesions
  4. Very common finding in Turners patients
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9
Q

Explain the “collateral” damage in Coarctation of the Aorta.

A
  • Due to the narrowing of the aorta, the pressure increases in the LV
  • Collateral vessels (intercostal arteries) that bypass coarctation, enlarge as well
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10
Q

What should you always include in your differential diagnosis of HTN in a 20-30 year old?

A

Coarctation of the aorta

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11
Q

If left unprepared, what is the sequelae of Coarctation of the aorta?

A

Development of CAD

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12
Q

On PE of an 18 y/o male, you notice a discrepancy in BP from LUE being greater than the RUE. Where is your suspected lesion of coarctation?

A

Pre ductal–lesion is proximal to the Left subclavian

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13
Q

On PE, you hear a mid-late systolic ejection murmur, heart best between the scapula and to the left of the spine with an ejection click. Based on this finding, what is the more likely diagnosis?

A

Coarctation of the aorta with an associated bicuspid valve

ejection click = associated bicuspid valve

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14
Q

On PE, you hear a mid-late systolic ejection murmur, heart best between the scapula and to the left of the spine with an ejection click. Based on this finding, what would you expect to see on a CXR of this patient?

A

Notching or scalloping of posterior surface of inferior ribs “3” sign

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15
Q

With a neonate recently diagnosed with severe Coarctation of the aorta, what is the best management?

A
  1. Give prostaglandin infusion to keep the PDA open to bypass coarctation
  2. Surgical correction
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16
Q

Which cardiac lesion carries a significant morbidity/mortality with a mean age of death at 38?

A

Coarctation of the aorta

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17
Q

Is PDA cyanotic or acyanotic?

A

Acyanotic

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18
Q

What are risk factors to developing PDA?

A
  1. First trimester Rubella infection
  2. Prematurity
  3. Birth at high altitude–due to a low oxygen concentration
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19
Q

When will PDA become cyanotic?

A

If pulmonary vascular disease occurs, then the patient can have Eisenmenger syndrome and become cyanotic

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20
Q

Explain the process of the ductus arteriosus closure.

A

Usually the ductus constricts after birth (10-15hrs) due to a sudden rise in the blood oxygen tension and reduction in the level of circulating prostaglandins

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21
Q

What sxs would you expect a patient with PDA to exhibit?

A
  • Small PDA: asxs
  • Moderate PDA: dyspnea, fatigue, and palpitations
  • Large PDA with a L to R shunt develop early HF usually within the first year of life
  • Afib can also occur
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22
Q

What is the most common cyanotic heart defect?

A

Tetralogy of Fallot

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23
Q

What is the congenital defect occurs in Tetrology of Fallot?

A

Abnormal anterior and cephalad displacement of the infundibular (outflow tract) `portion of the inter ventricular septum

  1. VSD
  2. Subvalvular pulmonic stenosis
  3. Overriding aorta
  4. RVH
24
Q

A 2 month old infant comes into the clinic for a well check. His mother says she notices her child “getting tired” during feeds. He is often irritable and seems to have a hard time breathing all the time. Mom says he often raises his legs to his chest and notices that this often soothes him. On PE, you see clubbing of fingers and toes. You also hear a systolic ejection murmur at the ULSB with a single S2. There is also a palpable RV heave. What would you expect this infants CXR to look like?

A

A boot

25
Q

A 2 month old infant comes into the clinic for a well check. His mother says she notices her child “getting tired” during feeds. He is often irritable and seems to have a hard time breathing all the time. Mom says he often raises his legs to his chest and notices that this often soothes him. On PE, you see clubbing of fingers and toes. You also hear a systolic ejection murmur at the ULSB with a single S2. There is also a palpable RV heave. What is the most likely diagnosis based on this information?

A

Tetralogy of Fallot

26
Q

A 2 month old infant comes into the clinic for a well check. His mother says she notices her child “getting tired” during feeds. He is often irritable and seems to have a hard time breathing all the time. Mom says he often raises his legs to his chest and notices that this often soothes him. On PE, you see clubbing of fingers and toes. You also hear a systolic ejection murmur at the ULSB with a single S2. There is also a palpable RV heave. What is the most appropriate treatment for this condition?

A
  • Surgery to close the VSD and make the outflow tract larger

- Requires prophylactic abx for 6 months after surgical repair

27
Q

Is VSD acyanotic or cyanotic?

A

Acyanotic

28
Q

Where are most VSDs located?

A

70% are membranous

20% are muscular

29
Q

What does a VSD murmur sound like?

A

-Harsh, holosystolic murmur LLSB that may radiate to right border

  • -does not radiate to the axilla
  • -does not increase on inspiration
  • Systolic thrill
  • Mid-diastolic rumble at apex
30
Q

What age do most VSDs close spontaneously?

A

Age 2

31
Q

When is surgery indicated before age 2 with patients with VSD?

A
  • If the defect is moderate to large

- OR There is any sign of pulmonary overload

32
Q

What age group does Rheumatic fever usually present in?

A

5-15 y/o

33
Q

What is Acute Rheumatic Fever?

A
  • Inflammatory disease that follows S. pyogenes (pharyngitis) (GAS) infection
  • It is an antibody cross-reactivity that can affect the heart, joints, skin, and brain 2-3 weeks post infection
34
Q

What is needed to make the diagnosis of Acute Rheumatic fever?

A

Jones Criteria:
-2 major
OR
-1 major and 2 minor w/ a recent hx of GAS

35
Q

What are the major Jones Criteria for diagnosing Acute Rheumatic Fever?

A
  1. Erythema Marginatum: circular, pink rings on the torso and inner surfaces of the limbs
  2. Carditis
  3. Polyarthritis of large joints (knees and ankles MC)
  4. Syndenham’s chorea
  5. Large nodules over bones
36
Q

What are the minor Jones Criteria for diagnosing Acute Rheumatic Fever?

A
  1. GAS positive swab
  2. Fever greater than or equal to 101.3F/38.5C
  3. Polyarthralgias
  4. Elevated ESR/CRP
  5. 1 degree AV Block
37
Q

What would be the appropriate tx for Acute Rheumatic fever?

A
  1. Best rest
  2. ASA or steroids
  3. Penicillin
  4. Erythromycin 40mg/kg/d
38
Q

What is Kawasaki disease?

A

Mucocutaneous lymph node syndrome found in children

39
Q

How is Kawasaki disease diagnosed?

A

5 out of the following 6 are needed to make the diagnosis:

  1. Fever lasting more than 4 days
  2. Bilateral non purulent conjunctivitis
  3. Red, dry lips; erythema of the oral mucosa; strawberry tongue
  4. Polymorphous truncal rash, desquamation of the fingers and toes
  5. Cervical lymphadenopathy (>1.5cm)
  6. Cardiac abnormalities***
40
Q

Which cardiac abnormalities should you look out for in a patient with suspected Kawasaki disease?

A

Within the first week to 10 days:

  1. Tachycardia out of proportion to the degree of fever
  2. Gallops
  3. Muffled heart sounds
41
Q

What are some complications/sequelae of cardiac complications of Kawasaki disease?

A
  1. CA aneurysms
  2. Depressed myocardial contractility and HF
  3. Myocardial Infarction
  4. Arrythmias
  5. Peripheral Arterial occlusion may also develop*
42
Q

T or F: Cardiac complications are not part of the diagnosis for Kawasaki disease.

A

T: not needed for Dx but support it since other diseases that mimic KD do not involve the heart

43
Q

What tx is appropriate for Kawasaki disease?

A

In the Acute stage: ASA + IVIG

In the convalescent stage: ASA (>14 d afebrile)

44
Q

Glancing at an EKG, you see LVH and LA enlargement, with arrhythmias, based on this and a history of a young person fainting while playing sports–what is the most likely diagnosis?

A

Hypertrophic Cardiomyopathy

45
Q

What are the two types of Hypertrophic Cardiomyopathy?

A
  1. Familial disease; Autosomal dominant pattern, variable penetrance
  2. 90% asymmetric hypertrophy of ventricular septum
46
Q

What is the effect of having a thickened ventricular septum?

A

LV contractile function is vigorous but the thickened muscle is stiff
Results in impaired ventricular relaxation and HIGH DIASTOLIC PRESSURES

47
Q

A 15 y/o girl is seen in the office complaining of dyspnea, PND, ortopnea, angina, and has a recent history of syncope. What would you expect her PE to reveal upon auscultation?

A
  • S4-severe hypertrophy
  • Double apical impulse
  • Systolic murmur of LV outflow obstruction: crescendo-descrendo, LLSB
  • Holosystolic murmur of MR at apex
  • ***Murmur INCREASES WITH VALSALVA AND DECREASES WITH SQUAT
48
Q

A 15 y/o girl is seen in the office complaining of dyspnea, PND, ortopnea, angina, and has a recent history of syncope. On PE, a holosystolic murmur at the MR at apex increases with valsalva and decreases with a squat. What is the best treatment/manangement at this time?

A
  1. BB, CCB, anti-arrhythimics, ICD implantation, IEP, Percutaneous septal ablation, myomectomy
  2. AVOID ionotropes and diuretics
49
Q

A 15 y/o girl is seen in the office complaining of dyspnea, PND, ortopnea, angina, and has a recent history of syncope. On PE, a holosystolic murmur at the MR at apex increases with valsalva and decreases with a squat. What extra studies are indicated to diagnose this patient?

A
  1. EKG
  2. Echo
  3. Cardiac Cath: pressure gradient outflow portion
50
Q

What is common about all types of Syncope?

A

Decreased cerebral perfusion

51
Q

What is the treatment for Neurogenic/Vasovagal syncope?

A

Liberalize salt/fluid intake

Beta blockers

52
Q

Which type of syncope is usually due to a volume depletion such as, gastroenteritis, or a failure to rehydrate after outdoor activities?

A

Orthostatic syncope

53
Q

What is needed to “officially” diagnose orthostatic syncope?

A

Documentation of a 20 mmHg or more fall in systolic BP during initial 5 min after patient stands upright

HR may increase or remain unchanged

54
Q

What is the appropriate tx for Orthostatic syncope?

A

Oral or IV rehydration

55
Q

What is cardiac syncope indicative of?

A

Hypertrophic cardiomyopathy

Pediatric Rotation (7 decks)

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