Cardiovascular

Question 1

When is universal dyslipidemia screening

Answer 1

Age 9-11 once
Age 17-21 once

Question 1

How often should children with obesity be screened? With what?

Answer 1

Every 1-3 years starting at age 2 for BMI >=95th percentile or >=30:

Fasting lipid panel
ALT (for NAFLD)
BP
Polysomnogram (for habitual snoring >=3 nights/week)
Hgb A1c or fasting glucose if other risk factors for diabetes are present

Question 2

Treatment for coarctation of aorta

Answer 2

Prostaglandin E1

Question 3

Signs and treatment for Tetralogy of Fallot “tet” spell

Answer 3

Knee-chest positioning (increases SVR by kinking femoral arteris)
Oxygen (Decreases PVR and increases SVR)
IV fluids (increases RV filling and pulmonary flow)

Question 4

Long QT treatment

Answer 4

Beta-blockers (non-specific best - propranolol, nadolol) - decrease sympathetic activity and shortens QT at higher heart rates

Question 5

Which antiarrhythmics should be avoided in long QT?

Answer 5

Class IA and III, sotalol - all inhibit repolarizing potassium channels, worsening QT interval

Question 6

What conditions can cause carotid pulse dual upstroke (pulse bisferiens)?

Answer 6

Aortic regurgitation
Hypertrophic obstructive cardiomyopathy
Normal hyperdynamic state

Question 7

What condition on chest X-ray has narrow mediastinum “egg on a string” appearance?

Answer 7

Transposition of the great vessels

Question 8

Transposition of great vessels has what signature features?

Answer 8

Cyanosis within first 24 HOL
Single S2 (absent pulmonary component because aorta now anterior)
Tachypnea

Question 9

How does polycythemia affect oxygen saturation and skin color?

Answer 9

Oxygen saturation is normal, but skin color can be cyanotic due to excess hemoglobin and many deoxygenated hemoglobin, compared to amount in normal neonate

Question 10

Besides innocent murmur, what other murmurs are detected in school-age children (as opposed to neonates)?

Answer 10

Atrial septal defect
Bicuspid aortic valve

Question 11

What is the most common heart defect presenting with cyanosis in the newborn period?

Answer 11

Transposition of the great arteries

Question 12

What heart defects do not cause CHF?

Answer 12

ASDs, cyanotic heart defects like tetralogy of Fallot

Question 13

What heart defects cause CHF?

Answer 13

VSD, coarctation of aorta, large PDA, severe aortic stenosis
Presents primarily with feeding difficulties and respiratory symptoms

Question 14

Treatment of CHF in infant

Answer 14

Furosemide
Enalapril or captopril (ACE inhibitors)

Digoxin

Question 15

Breath-holding spell warrants what screening?

Answer 15

Iron deficiency anemia; otherwise, episodes resolve by 5 yo and children develop normally

Question 16

Diabetic mother predisposes to what cardiomyopathy? What is treatment?

Answer 16

Hypertrophic cardiomyopathy - glycogen + fat deposition in interventricular septum –> dynamic LVOT obstruction

Treatment: Beta-blockers (propranolol) and IV fluids to increase LV blood volume to overcome obstruction
Lasts for a few weeks; insulin decreases and septal thickening reduces

Question 17

Explain the single S2 in Tetralogy of Fallot

Answer 17

Aortic sound without pulmonic sound, which is inaudible from pulmonary stenosis and harsh crescendo-decrescendo systolic ejection murmur

Question 18

Inspiration causes increased murmur sound in aortic or pulmonic regurgitation?

Answer 18

Pulmonic regurgitation murmur increases with inspiration

Aortic regurgitation murmur decreases with inspiration

Question 19

What are vascular causes of ischemic stroke in children?

Answer 19

Noninflammatory: arterial dissection (trauma)
Inflammatory: vasculitis (Takayasu, SLE); infection (bacterial meningitis)

Question 21

Noncyanotic heart shunts

Answer 21

ASD, VSD, PDA

Question 22

Ebstein anomaly caused by…

Answer 22

Prenatal lithium

Question 23

Supravalvular aortic stenosis caused by…

Answer 23

Williams syndrome