Cardiology Flashcards
A tall, thin 15yo male has a mid-systolic click best heard at the apex. The most likely diagnosis is:
- Mild aortic valve stenosis
- Bicuspid aortic valve
- Severe Pulmonary valve stenosis
- Mitral Valve prolapse
- An S4
- Mitral Valve prolapse
• Christina - 15yo girl with history of seizures
• Fainted while caving.
• Bat flew out. Difficulty breathing. Collapsed.
• Unconscious 5-10 minutes – friends could not wake her. Confused afterwards.
• No memory of event
• No seizure activity or incontinence noted
• Negative family history
• On exam: HR=54,
BP=98/56, afebrile.
Normal cardiac exam.
• An ECG shows LVH and a QTc=0.46. It is otherwise normal.
The most likely cause of Christina’s loss of consciousness is:
1. Long QT syndrome
2. Neurocardiogenic syncope
3. Congenital complete heart block
4. A seizure disorder
5. A ventricular arrhythmia
- Long QT syndrome
Which statement best reflects your assessment of an ECG with a delta wave?
- This patient is at risk of supraventricular tachycardia but not sudden death
- This patient is at risk of both supraventricular tachycardia and sudden death
- This patient is at risk of Torsades de Pointes
- This patient is likely to have had previous cardiac surgery
- This is a normal ECG
- This patient is at risk of both supraventricular tachycardia and sudden death
A 4-month-old with Brushfield spots has an ECG showing a normal axis and biventricular hypertrophy. The most likely diagnosis is:
- Atrioventricular septal defect
- Ventricular septal defect
- Atrial septal defect
- Acute leukemia
- Noonan Syndrome
- Ventricular septal defect
AVSD would have an extreme axis deviation
A 3-month-old male with a history of hypoplastic left heart syndrome underwent a Norwood operation with a Sano shunt at birth.
• His mother brings him for “RSV immunization” and you note he looks cyanotic. His saturation is 79%. He is afebrile, not in any distress, and the cardiac examination shows a single S1, and a single S2 with a systolic murmur at the LLSB. His liver is not enlarged and pulses are all palpable.
• The most appropriate action is:
A) Give the patient his palivizumab immunization as
planned
B) Send the patient to the emergency department for
admission
C) Call the cardiologist on call to arrange for an echocardiogram
D) Start antibiotics to treat what is likely a bacterial pneumonia causing desaturation
E) Defer the immunization until the patient’s saturation improves to greater than 90%
- Give the patient his palivizumab immunization as planned
14yo boy born with a double inlet left ventricle underwent an extracardiac fenestrated Fontan procedure at age 3y. He was well until last month when he developed a diarrhea and anasarca. The diarrhea persists. A urine dipstick is negative for blood and protein. The most likely diagnosis is:
- Glomerulonephritis
- Protein-losing enteropathy
- Crohn’s disease
- Post viral gastroenteritis
- Aspergillus infection
- Protein-losing enteropathy
Saira is a three year old girl with a working diagnosis of Kawasaki disease. She is admitted for treatment 8 days after onset of fever. An echo done on admission is normal.
The statement that most accurately reflects Saira’s risk of coronary aneurysms is:
A) There is no risk of coronary aneurysm development,
B) Based on her age, the risk of coronary aneurysm development is high
C) The risk of coronary aneurysm development is highest in the first 2 weeks after onset of fever
D) The risk of coronary artery aneurysms is highest in weeks 4-6 after onset of fever
E) Coronary aneurysms occur in about 40% of children with Kawasaki disease
D) The risk of coronary artery aneurysms is highest in weeks 4-6 after onset of fever
9yo Jane had a ventricular septal defect repaired in infancy. The procedure was complicated by development of endocarditis about 6 weeks post-op.
• The defect was completely closed but she was left with mild aortic insufficiency
• She falls on the playground and impacts a tooth. The dentist says it needs to be removed and wants to know if she needs antibiotic prophylaxis.
The correct answer is:
1. Yes, because aortic regurgitation is considered a high risk lesion for infective endocarditis and tooth extraction is a high risk procedure
2. No, as long as the VSD is fully closed, aortic regurgitation is not considered a high risk lesion for infective endocarditis
3. No, because tooth extraction is not a high risk procedure for infective endocarditis
4. Yes, because previous endocarditis makes her a high risk patient and tooth extraction is a high risk procedure
- Yes, because previous endocarditis makes her a high risk patient and tooth extraction is a high risk procedure
14 yo boy, previously healthy. Presents with recurrent central chest pain.
• Sleeping in recliner for a week because “it feels better.”
• There is no associated shortness of breath but sometimes it hurts to take a deep breath.
• From the list below, the most likely cause of this boy’s chest pain is:
A. Functional (non-cardiac) chest pain
B. Pericarditis
C. Atherosclerotic heart disease
D. Aberrent left coronary artery from the
pulmonary artery
E. Ischemic chest pain
B. Pericarditis
• A3 hour old infant is noted to look “dusky”at change of shift. The RN obtains a saturation of 70%. Other vitals are as follows: HR=150, RR=45, BP=65/48 (RA).
• Examination: Not dysmorphic, chest normal
• CVS:
– quiet precordium.
– HS – normal S1, single S2. No S3 or S4 and no clicks or
murmurs
– Liver is palpable at the costal margin.
• The most likely diagnosis is
A) Transposition of the great arteries with intact ventricular septum
B) Atrioventricular septal defect
C) Large ventricular septal defect
D) Tetralogy of Fallot
E) Partial anomalous pulmonary venous drainage
- Transposition of the great arteries with intact ventricular septum
A 2 month old infant is brought to the emergency department by her parents because of difficulty breathing and poor feeding for 2 weeks
• There is significant work of breathing and the patient’s weight is below the 3rd percentile. A loud systolic murmur is audible on exam.
• Of the following, the most likely diagnosis is:
A. Pericarditis with pericardial tamponade
B. Dilated cardiomyopathy
C. Atrioventricular septal defect
D. Total anomalous pulmonary venous drainage
E. Secundum atrial septal defect
- Atrioventricular septal defect
You are called to see a newborn male with tachycardia. He is connected to a heart monitor. The rhythm shown is observed (SVT). ABC’s are judged stable. Gagging fails to induce a change in rhythm.
- Electrical cardioversion
- Intravenous adenosine
- Intravenous propranolol
- Slow steady pressure on the eyes to increase vagal tone
- Ice to face
- Intravenous adenosine
A 10 year old girl is admitted with a 2 week history of fever unresponsive to amoxicillin, malaise and poor appetite.
• Examination reveals T=38.8°C, HR=110, RR=20, BP=103/68. There is a systolic murmur at the apex. A non-tender lesion is identified on the sole of the right foot.
The most likely diagnosis is:
1. Rheumatic fever because this is an Oslers node
2. Endocarditis because this is an Osler’s node
3. Rheumatic fever because this is a Janeway lesion
4. Endocarditis because this is a Janeway lesion
5. Kawasaki disease
- Endocarditis because this is a Janeway lesion
• A five year old girl presents with a history of decreased energy and appetite over the last 6 months, worse in the
last 3 weeks. She had also been SOB on exertion and
occasionally complained of chest pain on exertion.
• Past history is unremarkable.
• On examination
– Saturation 88% with mild clubbing
– left parasternal heave
– there is a normal S1, a single S2
– high-pitched 3/6 blowing systolic murmur best heard at the right lower sternal border
– the liver is 4cm below the right costal margin and pulsatile
• You order an echocardiogram. Which of the following is the echo most likely to find?:
A. A pulmonary artery sling
B. A hypertrophied, poorly functioning RV
C. Coarctation of the aorta
D. Severe aortic valve stenosis
E. Mild mitral regurgitation
B. A hypertrophied, poorly functioning RV
