Cardiology Flashcards
1
Q
- What is the most common presentation of a 2-day old newborn with cyanotic heart disease?
a. bounding/dynamic precordium
b. normal pulses and quiet precordium
c. decreased pulses and poor perfusion
d. tachypnea and nasal flaring
e. palpable thrill
A
Normal pulses and quiet precordium
2
Q
13. Cyanotic infant. CXR shows large heart and oligemic lung fields (question describes a CXR, but no actual CXR attached). Which lesion? A. ToF B. Truncus arteriosis C. TAPVD D. ASD --------- 15. A newborn has cyanosis. His CXR is as follows: (CXR shows slightly boot shaped heart with narrow mediastinum, oligemic lungs) a. TGA b. TAPVR c. Truncus arteriosus d. TOF
A
TOF
Oligemic = poor blood flow to lungs
- TOF
- Tricuspid atresia
- Pulmonary atresia
- Ebsteins
3
Q
- A baby is born post dates and had meconium stained amniotic fluid. After birth he is in respiratory distress. Both pre and post ductal sats are low. He fails a hyperoxia test. What is the diagnosis?
a. PPHN
b. MAS
c. TGA
A
TGA
If failed a hyperoxia test, this means that he has a cyanotic congenital heart disease rather than pulmonary disease
Mec stained AF suggests PPHN.
However in PPHN, would expect higher on pre-ductal and lower on post-ductal (deoxygenated blood shunts right to left across PDA)
4
Q
- Child with a moderately sized atrial septal defect. What is the most common presentation in an 18-month old with this?
a) asymptomatic
b) CHF
c) Exercise intolerance
d) recurrent respiratory infections
A
Asymptomatic
5
Q
- Patients with ASDs have a fixed split S2. This is due to:
a. pulmonary hypertension
b. abnormal pulmonary valve
c. pooling of blood in the pulmonary vasculature
d. prolonged right ventricle ejection
A
Prolonged RV ejection
6
Q
- Infant presents unwell. HR 136, RR50. EKG shows Qwaves in I, aVL, V5 and V6. CXR shows mild pulmonary edema. What is the diagnosis?
a. Anomalous left coronary artery from the pulmonary artery
b. VSD
c. TOF
A
ALCAPA
Lateral leads
CHF. Suggests volume overload or cardiac inability to handle the load
Based on the Q waves, this suggests myocardial dysfunction
7
Q
- Boy with TAPVD. Want to start ADHD med. What do you do?
a. Hx and PE and consult with cardiologist
b. ECG
c. Cardiology consult
d. ?Echo
A
Hx + PE + consult with cardio
8
Q
- 5 day old with tachycardia, tachypnea, cyanosis and left SaO2 is 91% and rights SaO2 is 98%. Best next step is:
a. start PGE1
b. give indomethacin
c. intubate
d. chest xray
A
Start PGE1
Ductal dependent pulmonary circulation: pulmonary blood flow for O2 is supplied by the systemic circulation via PDA => RVOTO
- Tricuspid atresia, pulmonary atresia, TOF, Ebstein
Ductal dependent systemic circulation: systemic blood flow is supplied by pulmonary circulation via PDA => LVOTO
- CoA
- Aortic stenosis
- HLHS
9
Q
- Infant with R arm sat of 90% and L leg sat of 70%. Pt tachypneic, RR 70, no distress. Dx?
a. CoA
b. truncus
c. TGA -
d. TOF -
——————
A 3 day old is seen in the nursery. He has an oxygen saturation of 90% in the right arm and 70% in the left leg. His respiratory rate is 70. What is the most likely diagnosis?
a. CoA
b. TGA
c. Truncus arteriosus
d. TOF
—————
24 hour infant with preductal sats 90%, post ductal sats 70% and RR 70/min
a. coarctation of aorta
b. truncus
c. TGA
d. TOF
A
CoA
- RA >20mmHg SBP gradient vs legs
- ECG: LVH +/- strain
- CXR: rib notching, “3” sign
Differential sats: High RA, low leg
CoA
PPHN
Reverse differential: low RA, high leg
TGA
10
Q
- 12h old Newborn has a sat of 80%. Increases to 85% with 100% 02. Mild tachypnea rr65. CXR has no abnormalities. What next initial management should be done?
a. Intubate and ventilate
b. Prostaglandins
c. Antibiotics
A
Most likely cyanotic heart disease
Prostaglandins
11
Q
- 12 hour old newborn with cyanosis, sats 80% increased to 85% on 100% O2. CXR normal pulmonary vasculature and no other anomalies. Most likely dx?
a. HLHS
b. TOF
c. TGA
d. Tricuspid Atresia
————-
A newborn baby presents with tachypnea and O2 sats of 80%. Sats increase to 85% on 100% O2. CXR reveals normal pulmonary vasculature and was otherwise normal. Most likely diagnosis:
a. HLHS -
b. tricuspid atresia
c. transposition of the great vessels
d. Tetralogy of Fallot
A
TGA
12
Q
- Infant with large VSD. The murmur cannot be heard. What is the cause?
a. VSD has closed
b. there is increased pulmonary outflow obstruction
c. pulmonary arterial pressures have increased
A
Pulmonary arterial pressures have increased
- initially VSD shunts L->R
- leads to pulmonary arterial HTN
- once pulm:systemic resistance approaches 1:1, shunt becomes bidirectional. Signs of cyanosis.
13
Q
- 4 year old healthy kid with slight systolic ejection murmur heard at LLSB and MLSB. There is a variable split S2. Exam is otherwise normal. Cause for murmur?
a) Benign
b) Bicuspid aortic valve
c) VSD
d) Pulmonary stenosis
A
Benign
- Systolic murmur
- Soft
- Changes with position
Bicuspid aortic valve: AR
VSD: holosytolic murmur
PS: SEM LUSB, fixed split S2
14
Q
- Murmur, LLSB, variable split S2, II/VI murmur
a) PS
b) Bicuspid AV
c) Benign
A
Benign
15
Q
8. Kid with soft murmur over left upper sternal border, and fixed split S2. Diagnosis? A. Pulmonary stenosis B. Mitral regurg C. ASD -------------- 14. 18m old boy noted to have soft high pitch murmur Grade 2 on left sternal border with fixed split S2 What is the Diagnosis? A. ASD B. Truncus C. ? D. ? -------------- 19. A 30 month old is found to have a normal S1 and fixed, split S2 on auscultation with a 2/6 murmur at the left upper sternal border. What is his ECG likely to show? a. Prolonged PR interval b. Signs of RV overload c. Left bundle branch block --------------- 54. 6y old boy, for check up and find on auscultation single s1 and wide, fixed split s2 with systolic murmur loudest at the LUSB. He appears well and is in no distress. Most likely explanation for the findings: a. ASD b. pulmonic stenosis c. TAPVR ------------- Exam with 2/6 SEM at LSB with normal S1 and widely split S2. what is the most likely diagnosis? a. ASD b. PS c. AS d. TAPVR
A
ASD
16
Q
9. A 14 year old female with significant family history of sudden cardiac death. Had 2 paternal uncles die of “heart attack”. She has a grade 2/6 SEM worse when standing up and she is hypertensive on exam. A. Holter B. Echocardiogram C. ECG D. ??
A
ECG - if asks for first test
ECHO - if asks for diagnosis
Worried about hypertrophic cardiomyopathy
- most murmurs get louder with squatting b/c increase venous return to heart
- Exception: HCM, which is louder standing from supine, softer squatting
17
Q
- A 5 year old girl is referred for assessment of a murmur heard by her family MD. She has a coarse murmur heard in the right subclavicular area when sitting up, and disappears when she lies down. What is the most likely diagnosis?
a. Stills murmur
b. Venous hum
c. Patent ductus arteriosus
d. ASD
- ——— - At a regular office visit, a 7 y.o. girl is noted to have a continuous murmur in the right subclavicular area (or supraclav?), that is louder when upright. She is well and has no other contributory medical history.
a. Still’s murmur
b. PDA
c. Venous hum
A
Venous hum
18
Q
- Infraclavicular murmur that is louder on sitting up
a. Venous hum
A
Venous hum
19
Q
- Newborn baby has a murmur. What do you do?
a. Follow closely
b. Send to family MD
c. Urgent cardio consult
A
Follow closely
20
Q
- Soft second heart sound with click. Left parasternal heave. Systolic murmur left upper sternal border.
a. pulmonary stenosis
b. ??
A
pulmonary stenosis
Clicks
- Aortic ejection click (AS, aortic dilation): RUSB, early systolic, constant in intensity
Note: if aortic click at apex, then bicuspid aortic valve
- Pulmonary ejection click (PS): LUSB, early systolic, varies with respiration, disappear with inspiration
- Midsystolic click at apex followed by systolic murmur = MVP
21
Q
- Teenage girl with recurrent syncope after prolonged standing. Has prodromal symptoms (lightheadedness, etc). What is the MOST likely diagnosis?
a) Neurocardiogenic
b) Long QT
c) Postural orthostatic tachycardia syndrome
A
Neurocardiogenic (vasovagal)
22
Q
- There is a 12 year old girl who has had episodes of syncope with exertion while she is playing soccer. She had a sister who died of SIDS last year at 9 months. What ECG finding would be most likely to give you the diagnosis?
A. Prolonged QTc
B. Wide QRS
C. Prolonged PR
A
Prolonged QTc
2 genetic causes of arrhythmias assoc’d with sudden death: long QT syndrome + Brugada
23
Q
- Obese teenager with hypertension and a history of two dead uncles from a “cardiac” cause when they were young. He comes to you for the feeling of “skipped beats”. What study will most likely give you the diagnosis?
A. 24 hour Holter
B. ECG
C. Exercise test
A
24H Holter
2 genetic causes of arrhythmia assoc’d with sudden death: long QT syndrome + Brugada
24
Q
- When would endocarditis prophylaxis be required for a patient with a history of endocarditis?
a. Dental cleaning
b. Umbilical piercing
c. Appendectomy
d. Myringotomy + tubes
A
Dental cleaning
25
Q
- Endocarditis prophylaxis is indicated for
a) TOF
b) MVP with MR
c) Bicuspid Ao Valve
- —– - Endocarditis prophylaxis [CPS]
a. TOF
b. VSD closed w residual leak
- —– - For which patient is prophylactic antibiotics before a dental procedure indicated for?
a. Unrepaired TOF
b. VSD that was repaired 10 months ago
c. VSD that was repaired 8 months ago with a small residual leak
d. Moderate aortic stenosis
A
TOF
26
Q
- What was the reason for revising guidelines for cardiac prophylaxis?
a. Cost effective
b. Infections were more likely from exposures from everyday life and not that much more from dental procedures
A
Infectious were more likely from exposures from everyday life and not that much more from dental procedures
27
Q
- What do you give a CHF kid (description of kid in CHF)
a. Furosemide
b. Digoxin
A
Furosemide
28
Q
- 6 wk old with pansystolic murmur, increasing respiratory distress and liver edge down. CXR shows increased pulmonary markings. Which medication would you consider to help his symptoms?
a. propanolol
b. furosemide
c. digoxin
d.adenosine
——
3 week? old baby with tachypnea RR 70, chest crackles, diaphoresis with feeding. Grade III/VI murmur pansystolic, liver at 5 cm below costal margin. Treatment:
a. digoxin
b. furosemide
c. prostaglandin
A
Furosemide
29
Q
- 2 month old baby in SVT (ECG is rapid, no P waves) - has been feeding poorly last few days. On exam has mild respiratory distress and no palpable peripheral pulses. What is most appropriate next step?
a) Carotid massage
b) Adenosine
c) Asynchronous counter shock
d) Digoxin
——–
Baby with poor pulses and looks unwell.
a) adenosine
b) asynchronized shock
c) vagal maneuvers
——– - Unstable SVT what to do
a) Amiodarone
b) Adenosine
c) Asynchronous Defib
d) Valsalva
A
Adenosine
if unstable, need SYNCHRONIZED cardioversion. Otherwise, risk of shocking on a T wave, causing Torsades
30
Q
- 8 month old baby with lethargy + poor feeding since yesterday. Today, HR 280 and pulses barely palpable. Weight is 8kg. What do you do next?
a. Defibrillation
b. Adenosine 0.8mg IV
c. Synchronized cardioversion
A
Adenosine 0.1mg/kg
31
Q
- Baby is refusing to feed since this morning. He is pale and lethargic over the last 24 hrs. HR 300, RR 70, weak pulses. What do you do? Baby weight 8kg
a. synchronized 4J cardioversion
b. synchronized 8J cardioversion
c. asynchronized 4J cardioversion
d. asynchronized 8J cardioversion
A
Synchronized cardioversion 0.5-1J/kg = 4 or 8J
32
Q
- Infant of diabetic mother with non-obstructive hypertrophic cardiomyopathy, child is macrosomic but otherwise asymptomatic, glucose fine, with no signs of heart failure; how will you manage the cardiomyopathy?
a. Treat with steroids
b. Treat with digitalis
c. Treat with diuretics
d. Will resolve without treatment
———-
What is the natural history of an infant with hypertrophic cardiomyopathy if the mom had gestational diabetes?
a. long term complications, requires transplantation
b. improves with digoxin and diuretics
c. spontaneous resolution
d. improves with beta-blockers
How does it present?
What do you see on CXR + ECHO?
How do I manage it?
A
Will resolve without treatment
IDMs at risk for transient hypertrophic cardiomyopathy
- often aSx
- 5-10% with resp distress, CHF
- CXR: +/- cardiomegaly
- ECHO: - thickening of interventricular septum + reduced size of ventricles -> potential LVOTO
- transient, will resolve as plasma insulin normalizes
- If Sx, typically recover in 2-3wks of supportive care
- ECHO findings resolve w/in 6-12mo
- Supportive care:
1) increase IV fluids
2) propranolol - inotropes are CONTRAINDICATED b/c can decrease ventricular size -> further obstruct cardiac flow
33
Q
- Infant presents pale, poorly perfused, big liver edge, looking like crap with HR of 260 after a few days of not acting right. Diagnosis:
a. cardiomyopathy
b. SVT
c. Metabolic disorder
A
SVT
34
Q
11. A boy put his finger in an electrical socket and has the rhythm below (torsades). He’s in Emerg receiving CPR and sats are 100%. What’s the next step? A. Intubate B. IV/IO epinephrine C. Synch 1J/kg D. Defibrillate 2J/kg
A
Defibrillate 2J/kg
Polymorphic VT = shockable rhythm
First line: MgSO4 25-50mg/kg IV/IO push
- for Tx + prevent recurrence
- even if normal serum Mg
- If pulseless arrest: give over 1-2min
- If not arrest: give over 15min (hypotension + asystole)
35
Q
- Kid with occasional PVCs, what’s the sports recommendation?
a. No restriction
A
No restriction
36
Q
- ECG tracing showing bradycardia/heart block. What are you most likely to find on maternal history?
a. Parvo
b. SLE
—————-
A newborn is found to have a rash and anemia. An ECG is shown with what looks like complete heart block (dissociation between p waves and QRS; QRS rate = 6 blocks apart: HR 50). What is the mostly like illness that would be found in the mother?
a. SLE
b. Hyperthyroidism
c. Addison’s
A
SLE
37
Q
- In the most common long QT syndrome (Romano-Ward), you ask about:
a. Deafness
b. Family history
- ——- - In a patient with Romano-Ward syndrome, what would suggest the diagnosis:
a. presence of cafe-au-lait spots
b. congenital defects
c. sensorineural hearing loss
d. family members have it.
A
Family history
Romano-Ward is AD, no SNHL
Jervell-Lange (song)-Nielsen is AR, SNHL
38
Q
- Long QT associated with?
a. hypokalemia
b. hypercalcemia
c. clarithromycin
d. digoxin
—————-
Which of the following can prolong a QT interval on an ECG?
a. Hypercalcemia
b. Hypokalemia
c. Clarithromycin
A
Clarithromycin
Hypokalemia
Both are right…
39
Q
2. What ECG change is characteristic of Rheumatic fever? Prolonged PR interval Sinus tachy -------- Which ECG change is characteristic of acute rheumatic fever? A. Peaked T waves B. Prolonged PR interval C. Sinus tachycardia D. Prolonged QRS -------- 7. Which ECG change is characteristic of acute rheumatic fever? A. Peaked T waves B. Prolonged PR interval C. Sinus tachycardia
A
Prolonged PR interval
40
Q
6. Newborn found to have cardiac rhabdomyoma. What syndrome is this associated with? A. Tuberous Sclerosis B. NF-1 --- An infant is diagnosed antenatally with a cardiac rhabdomyoma. What is the most likely diagnosis? A. NF1 B. TS C. WAGR D. Beckwith Weidemann
A
Tuberous sclerosis
41
Q
- A teenage boy has height at 90%, weight at 50%, scoliosis, pectus excavatum, and pes planus. What is the cardiac issue most likely to be seen on his echo?
a. Dilation of aortic root
b. Bicuspid aortic valve
c. Hypertrophic cardiomyopathy
d. Pulmonary stenosis
————– - Tall adolescent male with height at the 95%, weight at he 75% and arm span greater than length. What is the most likely finding on echocardiogram?
a. Bicuspid aortic valve
b. Dilatation of the ascending aorta
——————
Description of a patient with Marfan. Expected CHD
a. bicuspid AV
b. Dilated ascending aorta
c. VSD
—————— - 15 y o boy for regular check up and exam shows Ht > 95th, Wt 50%, arm span > ht, + pectus, flat feet. What is the most likely cardiac defect that could be found.
a. Mitral valve prolapse
b. Bicuspid Ao valve
c. Dilatation ascending aorta
d. VSD
A
Dilation of aortic root
Marfan’s
42
Q
- In fetal alcohol syndrome, what are the most common cardiac abnormalities seen?
a. Septal defects
b. TGA
c. Bicuspid aortic valve
A
Septal defects
Think F-ASD
43
Q
- How do you treat a child with hypertrophic cardiomyopathy?
a. Beta blocker
b. ACE inhibitor
c. Furosemide
- —- - Child with hypertrophic cardiomyopathy, what do you treat with?
a) Beta blocker
b) Ace inhibitor
c) Digoxin
d) Furosemide
A
Beta blocker
44
Q
- 14 yo s/p Fontan a few years ago, now diarrhea, and low albumin
a) Protein losing enteropathy
What is Fontan? When is it performed?
What are 3 early post-op issues?
What are 7 late post-op issues?
A
Protein losing enteropathy
Fontan
- performed 1.5-3yo
- anastomoses IVC to pulmonary arteries
- bypasses RV, abolishes R to L shunt
Post op issues A. Early 1. pleural or pericardial effusions 2. increased systemic vascular pressure 3. fluid retention
B. Late
- baffle obstruction -> SVC/IVC syndrome
- VTE
- protein losing enteropathy
- plastic bronchitis
- supraventricular arrythmias
- Hepatic cirrhosis
- LV dysfunction
45
Q
- Which cardiac defect is most likely in a child with 22q11?
a) TOF
b) VSD
c) Aortic coarctation
A
TOF
Conotruncal
TOF, VSD, interrupted aortic arch, TA, pulmonary atreisa, DORV
46
Q
- What’s the most common cardiac lesion in an IDM?
a. HCM
b. ASD
c. VSD
A
HCM
47
Q
- Girl with symptoms with high BMI and hypertension. Which of the following tests is MOST likely to reveal an underlying sequel of her disease?
a. Echo
b. Ecg
A
ECHO for LVH
48
Q
- Newborn diagnosed with interrupted aortic arch, what to start?
a. dopamine
b. prostaglandin
c. nitric oxide
d. Indomethacin
A
Prostaglandin
Interrupted aortic arch is the most severe form of CoA
Type A: between L subclavian + insertion of ductus arteriosus
Type B: between L subclavian + L carotid arteries
Type C: between L carotid + brachiocephalic arteries
Differential sats
***Ductus arteriosus provides sole source of blood to descending aorta
Need PGE1 until surgical repair
O/W when duct closes, CHF + shock
49
Q
- Child on risperdol for Tourette syndrome has frequent syncopal episodes with exertion. What is the cause?
a. hypoglycemia
b. Prolonged QT
A
Prolonged QT
