Cardiovascular

Question 1

If a child has >95% SpO2 on RH and >3% diff in foot, (age 24h-48h), what’s the next step

Answer 1

repeat pre- and post- in 1 hour

if still positive screen?
REPEAT 1 MORE TIME

Question 2

How many chances do you get to test for pre- and post-ductal saturation? What’s the cut off for definitely positive cardiac screen?

Answer 2

3 until you can say it is positive (keep repeating every hour)

<90% in RH or F

Question 3

Treatment of acute rheumatic fever

Answer 3

PO penicillin and Aspirin

Question 4

Jones criteria

Answer 4

Major (need 2, or 1 + 2 minor):
Joint pain
Heart invlvement
Nodules SQ
Erythema marginatum
Sydenham chorea

Minor: polyarthralgia
fever
ESR/CRP
Prolonged PR

Question 5

SVT tx

Answer 5

adenosine if stable
synchronized cardioversion if not

Question 6

Management of a NON CRITICAL pulmonary stenosis vs. Critical

Answer 6

Non critical (normal pulse ox): urgent cardiology eval and RHC for ballon valvuloplasty

Critical (hypoxia): prostaglandin

Question 7

cardiac disorder associated with Turner syndrome

Answer 7

coarcation of aorta

Question 8

Most common pathogen for infective endocarditis

Answer 8

S. aureus

Strep viridians (sanguinis, mitis, oralis, anginosus)

AACEK family less frequently

Question 9

Duke criteria

Answer 9

2 major, 1 major and 3 minor, or 5 minor

Major:
1. + blood culture for IE (typical microorganism from 2 separate blood cultures, or single coxiella burnetii or IgG titer >1:800)
2. Evidence on echo

Minor:
1. Predisposing heart condition or IV drug use
2. Fever >38
3. Vascular phenomena (arterial emboli, septic pulm infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, janeway lesions
4. immunologic (osler’s nodes, roth spots, RF
5. Microbiological evidence

Question 10

You suspect a child has heart failure in outpatient setting, what do you do?

Answer 10

start furosemide and send to cardiologist

Question 11

What’s the differnce between Ebstein’s anomaly and other cyanotic lung disease?

Answer 11

Aside from Tetrology of Falot when there may be pulmonary stenosis, Ebstein anomaly has DECREASED pulmonary blood flow.

The issue is not pulmonary overcirculation

Question 12

Issue with Ebstein anomaly

Answer 12

tricuspid valve is mis-positioned/improperly formed

Question 13

5 Ts of cyanotic heart disease

Answer 13

Truncus arteriosus
Tetrology of Fallot
Total anomaly of pulmonary venous return
Transposition of great arteries
Tricuspid atresia (can also be Ebstein)

Question 14

Cardiac defect associated with tuberous sclerosis

Answer 14

rhabdomyomas

Question 15

What do you look for in anamolous coronary artery from pulmonary artery?

Answer 15

Worsening feeds later in life as pulmonary vascular resistance decreases.

Deep Q waves

Question 16

Stages of HF

Answer 16

A: increased risk, normal function and structure
B: abnormal chamber size / function, no sx of HF
C: structural/functional issues + sx
D: end stage req inotropic support

Question 17

Treatment of HF in children

Answer 17

First line: ACE-i ** (not b-blocker like in adults)
Second: B-blocker (not atenolol)
3rd ARB
4th: diuretic (stage C)
5th: digoxin

Question 18

If you see reverse differential cyanosis (LE with higher SpO2 than RH), what do you think of?

Answer 18

transposition of great arteries

Question 19

Characters of an innocent murmur

Answer 19

2/6
timing during systole
low pitch
vibratory
L sternal border without radiation
volume louder when supine (if doesn’t change, likely pathologic)

Question 20

Tx of pericarditis

Answer 20

NSAID
+/- colchicine
steroids for recurrence (+/-)

Activity restriction

Question 21

Long term treatment of acute rheumatic fever

Answer 21

Pen G IM monthly for 5-10 years
OR
pen VK bid PO
OR
Sulfadiazine/sulfisoxazole PO daily
OR
Macrolide PO