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Pediatrics A > Cardiology (Victor) > Flashcards

Cardiology (Victor) Flashcards

0
Q

Most often infective endocarditis is a complication of ___ or ___

A

Congenital

RHD

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1
Q

Three types of infective endocarditis

A

Acute
Subacute
Nonbacterial

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2
Q

T/F. Infective endocarditis can occur in children without heart diease

A

True

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3
Q

Rare in what age groups to have infective endocarditis

A

Infancy

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4
Q

The leading etiology of infective endocarditis

A

Streptococcus viridans

Staphylococcus aureus

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5
Q

Etiology in patient with infective endocarditis without heart disease

A

Staphylococcus endo

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6
Q

Etiology in patient with infective endocarditis after a dental procedure

A

Streptococcus viridans

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7
Q

Etiology in patient with infective endocarditis in lower bowels or GU manipulation

A

Group D enterococci

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8
Q

Etiology in patient with infective endocarditis with IV drug users

A

Pseudomonas

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9
Q

Etiology in patient with infective endocarditis after an open heart surgery

A

Fungal orgs

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10
Q

Etiology in patient with infective endocarditis with indwelling catheters

A

CONS

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11
Q

Two important factors in the pathogenesis of infective endocarditis

A

☑️ Presence of structural abnormalities of the heart

☑️ Bacteremia

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12
Q

Conditions that predispose to endocarditis:

A 
All CHD except ASD secundum
Rheumatic heart disease
Prostetic heart valves
MVP with mitral regurgitation
HOCM
Drug addicts
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13
Q

Vegetation of infective endocarditis are found in the __ pressure side of the heart

A

LOW

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14
Q

80-90% of patients with IE will have this sign

A

Fever (38-39)

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15
Q

100% of patients with IE will have this sign

A

New heart murmur

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16
Q

50% of the patients with IE will have the following skin manifestations

A

Petechiae
Oslers nodes
Janeway lesion
Splinter hemorrhages

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17
Q

Tender nodes at the fingers

A

Osler node

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18
Q

Hemorrhagic areas at palms and soles

A

Janeway lesions

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19
Q

Linear lesions beneath the nails

A

Splinter hemorrhage

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20
Q

Embolic phenomena in IE patients

A 
Pulmonary emboli
Seizure
Hemiparesis
Hematuria
Roth spots
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21
Q

Positive blood culture in IE patients usually yields __%

A

90%

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22
Q

Anemia is associated with in IE patients

A

Leukocytosis

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23
Q

In echocardiography, these are seen in IE patients

A

Evidence of vegetations

Valve dysfunction

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24
Q

Other laboratory findings:

A 
Elevated ESR and CRP
Microscopic hematuria
Hypergammaglobulinemia
Rheumatoid factor
Azotemia
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25
Q

Presumptive impression of IE includes

A

Fever + underlying heart disease + any of the physical findings or laboratory changes

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26
Q

Definitive diagnosis of IE will include:

A

Positive blood culture or Demonstration of vegetation in ECHO

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27
Q

What criteria is to be used in diagnosis of IE

A

Duke’s criteria

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28
Q

Duke criteria includes how many minor and/or major to have a definite endocarditis

A

1 major + 3 minors

5 minors

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29
Q

Major criteria in Dukes

A

Positive blood culture

Evidence of endocarditis on Echocardiography

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30
Q

Minor criteria in dukes

A

Predisposing conditions
Fever
Embolic vascular sign
Immune complex phenomena
Single positive blood culture or serologic evidence of infection
ECHO signs not meeting the major criteria

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31
Q

Prognosis in patients with IE and HF

A

50-60%

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32
Q

Treatment for IE

A

Penicillin or Oxacillin + GENTAMYCIN

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33
Q

Usual duration of treatment for IE

A

4-6 weeks

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34
Q

This IE has a poor prognosis and difficult to manage, give the treatment.

A

Fungal endocarditis = AMPHOTERICIN B

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35
Q

Prophylaxis with dental procedure is negligible in the following:

A

☑️ secundum ASD
☑️ surgical repair of ASD, VSD, PDA without residua or beyond 6 months repair
☑️ previous coronary artery bypass surgery
☑️ functional heart murmur
☑️ previous kawasaki or rheumatic heart disease without valve dysfunction
☑️ cardiac pacemakers
☑️ implantable defibrillators

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36
Q

Prophylactic regimen for IE patients:

Standard general prophylaxis

A

Amoxicillin
Child: 50 mg/kg PO 1 hr before procedure
Adult: 2g PO 1 hr before procedure

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37
Q

Prophylactic regimen for IE patients:

Unable to take oral medications

A

Ampicillin
C: 50 mg/kg IM or IV 30 mins before procedure
A: 2 g IM or IV within 30 minutes before procedure

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38
Q

Prophylactic regimen for IE patients:

Allergic to penicillin

A

CLINDAMYCIN orally before 1 hour
C: 20 mg/kg
A: 600 mg

CEPHALEXIN orally before 1 hour
C: 50 mg/kg
A: 2 grams

CEFADROXIL

CLARITHROMYCIN orally before 1 hour
C: 15 mg/kg
A: 500 mg

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39
Q

Prophylactic regimen for IE patients:

Allergic to penicillin and unable to take oral medications

A

CLINDAMYCIN IM/IV within 30 mins
C: 20 mg/kg
A: 600 mg

CEFAZOLIN IM/IV
C: 25 mg/kg
A: 1 gram

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40
Q

Inflammatory process mediated by an immunologic reaction initiated by strep infection occuring in certain susceptible individuals predispose to this disease

A

Rheumatic fever

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41
Q

The attack rate of rheumatic fever with prevalence of ___

A

3%

1/1000

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42
Q

Incidence of both initial and recurrences of RF peak in children in ages ___

A

5-15 years

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43
Q

Worldwide this remains as the most common form of acquired heart disease in all age groups

A

Rheumatic fever

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44
Q

RF may affect many parts of the body particularly:

A

Joints
Heart
Brain
Skin

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45
Q

The most serious complications of RF

A

Valvular damage

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46
Q

Highest predilection of valvular damage in RF

A

Mitral valve > aortic valve > tricuspid valve > pulmonary valve

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47
Q

In RF sx are seen ___ weeks after strep throat infection

A

3-5 weeks

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48
Q

Average latent period in RF

A

3 weeks after infection

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49
Q

Chorea in RF have a longer latent period of ___

A

3-6 months

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50
Q

S/sx of RF may be classified under __ criteria

A

Jones criteria

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51
Q

Risk factors in RF usually affects ___ age level

A

School

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52
Q

Risk factors of RF includes living in:

A

Crowded conditions
Unsanitary conditions
Malnutrition

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53
Q 
Characteristic of strep throat as to:
Age
Onset
Initial sx
Apperance of throat
Fever
Other signs
A 
5-15 yo
Sudden
Sore throat with pain on swallowing
Redness, Hyperemia, Edema, Enlargement of tonsils with exudates
High
- Tender anterior cervical LN
- Scabby erosions on nostrils
- Clinical picture of scarlet fever
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54
Q 
Characteristic of non-strep throat as to:
Age
Onset
Initial sx
Apperance of throat
Fever
Other signs
A 
All ages
Gradual
Mild sore throat
Redness of pharynx
Not so high
- Cough
- Hoarseness
- Watery nasal discharge
- Conjunctivitis
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55
Q

The initial acute attack of RF can be detected by the Jones criteria with how many major minor?

A

2 majors

1 major + 2 minor

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56
Q

The major criteria in jones

A 
Carditis
Polyarthritis
Erythema marginatum
Subcutaneous nodules
Chorea
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57
Q

The minor criteria in jones

A

Arthralgia
Fever
Increased acute phase reactants
Prolonged QT intervals

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58
Q

Evidence of antecedent Group A strep infection

A

Positive throat culture or rapid strep antigen test

Elevated rising strep Ab (ASO) titer of atleast two fold from base

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59
Q

3 circumstances not require strict adherence to Jones criteria

A

Chroea as only manifestation
Indolent carditis as only manifestation
Recurrences of ARF may not fulfill the jones criteria

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60
Q

The most common symptoms of RF which is 75%

A

Arthritis

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61
Q

Arthritis in RF affects large joints such as:

A

Knee
Ankle
Elbow
Wrist

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62
Q

Besides the arthritis to be hot, red, swollen, and exquisitely tender its is also ___ and ___

A

Asymmetric

Polymigratory

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63
Q

Athritis in RF usually resolves spontaneously without leaving any deformity, it is usually treated by ___

A

Aspirin (salicylates)

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64
Q

Often there is an ___ relationship between the severity of arthritis to serverity of ____

A

Inverse

Carditis

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65
Q

The most serious complication of RF, which issues ___

A

Carditis

50-60%

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66
Q

Carditis in RF varies in the sense it includes:

A

Organic heart murmur
Heart enlargement
Tachycardia
Heart failure

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67
Q

Heart failure seen in carditis in RF is associated with

A

Cardiomegaly
Hepatomegaly
Peripheral and pulmonary edema

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68
Q

Carditis in RF is indicated by:

A 
Apical systolic murmur
Apical mid-diastolic murmur
Basal diastolic murmur
Friction rub
Gallop rhythm
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69
Q

Carditis in RF may present as:

A

Chest pain
Palpitation
Dyspnea

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70
Q

Most cases of RF carditis will consist of either ___ or a ____

A

Isolated mitral valve involvement

Combined mitral and aortic valvular disease

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71
Q

This is characterized by a HIGH PITCHED APICAL HOLOSYSTOLIC MURMUCR radiating to the ___

A

Mitral regurgitation

Axilla

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72
Q

If carditis is associated with APICAL MID-DIASTOLIC MURMUR

A

Mitral stenosis

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73
Q

This is characterized by HIGH PITCHED DECRESCENDO DIASTOLIC MURMUR at the upper sternal border

A

Aortic insufficiency

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74
Q

This is the universal finding in carditis of RF

A

Endocarditis

75
Q

ECG findings in carditis of RF

A

Disproportionate sinus tachycardia
Prolonged PR interval
Prolonged QT interval
Conduction defects with AV block

76
Q

This is not a pertinent finding in carditis in RF

A

Chamber enlargement

77
Q

Chest xray finding in carditis in RF

A

Heart enlargement

Plumonary congestion to frank pulmonary edema

78
Q

ECHO findings of carditis in RF

A

Mitral valve prolapse esp anterior leaflet
Echodensities or focal nodularities of the leaflet
Chamber enlargement (LA and LV)
Decreased ventricular contraction
Pericardial effusion
Aortic and Mitral regurgitation
Color flow abnormality in MR, AR, and TR

79
Q

This accounts to 10-15% of RF manifestation

A

Chorea

80
Q

Other name of Chorea in RF

A

St. vitus dance

81
Q

Triad of chorea in RF

A

Involuntary muscle movement
Muscle weakness
Emotional disturbances

82
Q

Chorea in RF is more common

A

Female

83
Q

When will the manifestation of chorea in RF will disappear?

A

During sleep

84
Q

Clinical maneuvers to elicit features of chorea

A

Milkmaid’s grip
Spooning and pronation of hands
Wormian darting of tongue upon protusion
Examination of handwriting to evaluate motor movements

85
Q

This RF manifestation is a rare type which accounts to 10% and can be seen in patients with carditis

A

Erythema marginatum

86
Q

Erythematous, serpiginous, macular lesion with pale centers, non pruritic, found in the extremities that spares the face

A

Erythema marginatum

87
Q

This manifestation of RF is accentuated with warming of the skin

A

Erthyma marginatum

88
Q

Another rare manifestation of RF which is small, non-tender pea sized nodules that appears in the extensor surface of jts

A

Subcutaneous nodules

89
Q

Manifestation of RF which is in association of carditis

A

Erythema marginatum

Subcutaneous nodules

90
Q

Subcutaneous nodules in RF is uncommonly seen because it only last for ____ weeks

A

1-2 weeks

91
Q

This is a result of inflammation and scarring of heart valves csused by RF or as a complication of RF

A

Rheumatic heart disease

92
Q

This is an absolute requirement for dx of ARF

A

Antecedent group A Strep infection

93
Q

Increase ASO in __% in ARF patients

A

80-85%

94
Q

Rise of ASO is seen in __ and peaks at __ decrease after __ months

A

1-2 weeks
4-6 weeks
2 months

95
Q

ASO titer in children? Adult?

A

Children: >= 330
Adult: >= 250

96
Q

The titers of ASO is normal in ___ and ___

A

Chorea

Chronic carditis

97
Q

Primary prevention of RHD drugs to be given are:

A 
Benzathine Pen G
Pen V
Erythromycin Estolate
Ethylsuccinate
Azithromycin
98
Q 
The duration of the following:
Benzathine Pen G
Pen V
Erythromycin estolate
Ethylsuccinate
Azithromycin
A 
Once
10 days
10 days
10 days
5 days
99
Q

Dose of Benzathine Pen G

A

1.2 MU

100
Q

Dose of Pen V

A

Children: 250 mg TID
Adult: 500 mg TID

101
Q

Dose of Erythromycin estolate

A

20-40 mg/kg/day, 2-4x/day (max 1 grams/day)

102
Q

Dose of Ethylsuccinate

A

40mg/kg/d; 2-4x/d (max 1g/d)

103
Q

Dose of azithromycin

A

500mg on 1st dose

250 mg on next dose

104
Q

This si given to patients who have already developed RF, this is to prevent recurrent attacks

A

Secondary prevention or prophylaxis

105
Q

The chemoprophylaxis for recurrences of acute rheumatic fever

A

Pen G Benzathine
Pen V
Sulfadiazine or Sulfisoxazole
Erythromycine

106
Q

The dose of Pen G Benzathine

A

1.2 MU every 4 weeks

107
Q

The dose for Pen V

A

250 mg BID

108
Q

The dose of sulfadiazine or sulfisoxazole in 27?

A
  1. 5 grams once a day

1. 0 grams once a day

109
Q

For chemoprophylaxis in patients with recurrence of acute rheumatic fever who are allergic to penicillin and sulfonamide drugs

A

Erythromycin

110
Q

Erythromycin dose

A

250 mg BID

111
Q

Duration of secondary prophylaxis:
RF without carditis
RF with carditis but no residual heart disease
RF with carditis and with residual hear disease

A

5 yo to 21 yo
10 yo until adulthood
Atleast 10 years until lifelong

112
Q

Acute febrile illness condition primarily affecting young children

A

Kawasaki disease

113
Q

Initially kawasaki disease is called __?

A

Mucocutaneous lymph node syndrome

Infantile polyarthritis mucosa

114
Q

Suspected etiology of kawasaki disease

A

Bacterial toxin similiar to staphylococcal toxins of TSS

115
Q

This is the leading cause of acquired heart disease in US and recognized worldwide

A

Kawasaki disease

116
Q

Peak age incidence of Kawasaki disease

A

1-2 years

117
Q

50% of cases of Kawasaki occur before the age of? How about the 80%? It is seldom seen in __ age

A

Before 2 years old
Before 5 years old
Beyond the age of 8

118
Q

Highest incidence ratio males vs female of kawasaki

A

1.4:1

119
Q

What are the 6 CHARACTERISTIC CLINICAL SIGNS of Kawasaki

A

Fever >5 days + :

  • Bilateral nonpurulent conjunctival injection
  • Changes in the mucosa of the oropharynx
  • Changes of the peripheral extermities
  • Erythematous rash
  • Cervical lymphadenopathy
120
Q

In kawasaki disease fever is more than ___ days, high, sustained or continuoous/ abrupt, pesk of ___, it can even presist till ___, resolves in __ days with the IV globulin

A

More than 5 days
Temperature exceeds 40’C
Perisist for 12 days
1-2 days

121
Q

In conjunctival injection of kawasaki its is term as clean because ___ and ___

A

No ocular discharge and No ulcers

122
Q

Changes in the mouth of patients with kawasaki involves the changes in the lips? Oropharynx? Tongue?

A

Erythematous, Fissuring, Peeling, Bleeding
Diffused erythema
Strawberry tongue

123
Q

Acute phase which involves __ days in kawasaki, peripheral extremities has ___ and ___

A

Firm induration of the hands and feet

Deep and diffuse erythema of the hands and sole

124
Q

Subacute phase which is __ week will cause __ of the extremities

A

Desquamation of the finger and toes

125
Q

Convalescent phase that happens __ months in kawasaki disease

A

2-3 months

Beau’s line - transverse groove across the fingernails

126
Q

Three forms of erythemal rash in kawasaki disease

A
  • truncal, polymorphous, non-vesicular and without crust
  • maybe morbilliform, maculopapular, scarlantiniform
  • may resemble erythema multiforme
127
Q

This clinical sign of kawasaki occurs in more than half of patients

A

Enlarged lymph node

128
Q

Enlarged lymph node in kawasaki disease is usually ___ and ___, and measure ___, non fluctuant and non tender / slight tender

A

Unilater and Cervical

> 1.5 cms

129
Q

Incomplete or atypical kawasaki is found in patients ___

A

< 1 year of age

130
Q

What criteria can we used in an atypical kawasaki disease

A

Fever more than 5 days + 2/3 principal features of kawasaki disease

131
Q

Laboratory findings in atypical kawasaki disease

A 
Leukocytosis (>15,000)
Anemia
Elevated ESR and CRP
Abnormal plasama lipid
Hypoalbuminemia
Hyponatremia
Thrombocytosis
Sterile pyuria
Elevated serum transaminase
2d echocardiogram
132
Q

Universal laboratory finding in kawasaki disease

A

Elevated ESR and CRP

133
Q

Thrombocytosis in kawasaki disease usually appears __ week, peak __, gradual return __ week

A

2nd week
3rd week
4-8 weeks

134
Q

Prognosis of kawasaki disease (2)

A

Complete recovery IN THOSE WITHOUT coronary vasculitis

1-2% die due to cardiac complications: HF, ARRHYTHMIA, MI

135
Q

Measles and varicella immunizations should be deffered for __ months after a child receives high dose of IVG

A

11 months

136
Q

IVIG should be given within __ days from onset of fever in kawasaki disease

A

10 days

137
Q

Disease of the heart muscle which is not associated with congenital, valvular, and coronary heart disease

A

Cardiomyopathies

138
Q

Primary causes of cardiomyopathies? Secondary cause?

A

Genetics

Infection
Endocrine
Metabolic
Nutritional

139
Q

Epidemiology of dilated cardiomyopathy vs hypertrophic, restrictive cardiomyopathy

A

36/100,000

2/100,000

140
Q

The most common chamber dilation in dilated cardiomyopathy, as to systolic function

A

LEFT ventricle

Decreased

141
Q

In hypertrophic cardiomyopathy there will be an ____ in ventricular myocardial wall thickness, as to systolic function, as to diastolic

A

Increased
Normal or increased
Decreased

142
Q

How is the chambers on restrictive cardiomyopathy? Ah to systolic function, as to diastole

A

Normal ventricular chamber size
Normal or combined with systolic dysfunction
Dramatically impaired diastole

143
Q

In arrythmogenic RV cardiomyopathy how is the systolic function?

A

Normal to decreased systolic function

144
Q

This is a form or dilated or restrictive cardiomyopathy

A

LV noncompaction

145
Q

ECG diagnosis of restrictive cardiomyopathy

A

Prominent P waves
Atrial fibrillation
Supraventricular tachycardia

146
Q

CXR in restrictive cardiomyopathy

A

Mild to moderate cardiomegaly

Pulmonary congestion or effusion

147
Q

Diagnostic ECHO of restrictive cardiomyopathy

A

Enlarged atria and small to normal sized ventricles

148
Q

Most common type of cardiomyopathy

A

Dilated cardiomyopathy

149
Q

Etiologies of dilated cardiomyopathies

A

NM
Inborn error of metabolism
Genetics
Idiopathic

150
Q

Incidence of dilated cardiomyopathy

A

Higher in males
African american
< 1 yo

151
Q

Pathophysio of dilated cardiomyopathy

A

Varying degrees of mycocyte hypertrophy and fibrosis

Weakening of systolic contraction associated with dilation of the four chambers

152
Q

ECG in dilated cardiomyopathy

A

Sinus tachycardia

Nonspecific T wave abnormalities

153
Q

CXR of dilated cardiomyopathy

A

Cardiomegaly

154
Q

ECHO of dilated cardiomyopathy

A

Dilatation of heart

Poor contractility

155
Q

About __ of patients die from intractable heart failure within __ years after the onset of symptoms of CHF

A

2/3

4 years

156
Q

Familial disorder of the heart muscle

A

Hypertrophic cardiomyopathy

157
Q

30-60% of hypertrophic cardiomyopathy is transmitted as __ trait

A

AD

158
Q

The most characteristic abnormality is ___ with ventricular cavity usually ___ or ___ in hypertrophic cardiomyopathy

A

Hypertrophic LV

Normal or small

159
Q

50% of patients with hypertrophic cardiomyopathy will be presenting with __

A

Murmur

160
Q

Family history usually __% for the disease of hypertrophic cardiomyopathy

A

30-60%

161
Q

Sudden death may occur in hypertrophic cardiomyopathy with an incidence of __/year

A

4-6%

162
Q

In PE what can be seen in patients with hypertrophic cardiomyopathy

A

Overactive precordial impulse with a lift or heave
Abnormal peripheral pulse
MR murmur is often present

163
Q

ECG findings in patients with hypertrophic cardiomyopathy

A

LVH with or without ST DEPRESSION

Abnormally deep q wave

164
Q

The CXR of hypertrophic cardiomyopathy

A

Mild cardiomegaly with prominence of LV

165
Q

ECHO of hypertrophic cardiomyopathy

A

LVH predominantly affecting the interventricular septum
Concentric hypertrophy of LV
LV outflow obstruction

166
Q

Risk of sudden death in hypertrophic cardiomyopathy is seen in:

A 
Hx of Cardiac arrest
VTAC
Exercise hypotension
Syncope
Excessive LV thickness >3cm
LVOT gradient of > 30 mmHg
167
Q

Refers to inflammation, necrosis or mycocytolysis of myocardial cells

A

Myocarditis

168
Q

The etiology of myocarditis

A

Adenovirus
Coxsackie virus
Enterovirus

169
Q

Suspected if child presents with unexplained shortness of breath or fatigue, a new arrhythmia or acute cardiac failure just following a viral illness

A

Myocarditis

170
Q

In myocarditis, the younger the patient, more toxic presentation:
Early infancy
Toddler or young childern
Older children

A

Acute, Fulminant
Less fulminant
Asymptomatic

171
Q

ECG of a myocarditis

A

Low QRS voltage
ST T changes
Arrhythmia

172
Q

The most important clinical sign of myocarditis

A

Varying degree of cardiomegaly in CXR

173
Q

This test is elevated in association with a ST segment elevation on ECG

A

CK MB

174
Q

This test is elevated in IDIOPATHIC MYOCARDITIS

A

LDH

175
Q

This test is elevated upto one month after infection in myocarditis but it is NONSPECIFIC for the disease

A

Troponin I

176
Q

Standard criterion in the diagnosis of Myocarditis

A

Endomyocardial biopsy

177
Q

Management of myocarditis

A 
Bed rest and limitation of activities
Anticongestive
High dose of immunoglobulin
Arrhythmia treated aggressively
Vasodilators
Corticosteroids
178
Q

75% in neonates that have myocarditis will present with

A

Mitral regurgitation

179
Q

Majority of patients with mild inflammation in myocarditis will:

A

Recover completely

180
Q

Patients who develop chronic mycarditis will also present:

A

Persistent cardiomegaly

181
Q

Myocarditis may be a precursor to:

A

Idiopathic dilated cardiomyopathy

182
Q

Acute inflammation of the pericardium

A

Pericarditis

183
Q

Drugs that causes pericarditis

A 
Procainamide
INH
Hydrazalaine
Cromolyn dantrolen
Methysergide
Anticoagulants
Thrombolytic
Phenytoin
PCN
Phenybutazone
Doxorubicin
184
Q

Constrictive pericarditis is usually observed in what etiology?

A

Bactrial and TB

Pediatrics A (9 decks)

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