Cardiovascular

Question 1

Systolic ejection crescendo-decrescendo best heard at pulmonic area. Widely fixed, split S2

Answer 1

Atrial septal defect

Question 2

Usually asymptomatic until > 30 y/o

Answer 2

Atrial septal defect

Question 3

Diagnosis of atrial septal defect

Answer 3

CXR: cardiomegaly
ECG: incomplete RBBB
Echo: gold standard

Question 4

Management of atrial septal defect

Answer 4

Spontaneous closure likely in first year so may observe if small
Surgical correction if symptomatic

Question 5

Bilateral lower extremity claudication

Answer 5

Coarctation of the aorta

Question 6

Systolic blood pressure in upper extremities > lower extremities, delayed or weak femoral pulses

Answer 6

Coarctation of the aorta

Question 7

Systolic murmur that radiates to the back/scapula/chest

Answer 7

Coarctation of the aorta

Question 8

Diagnosis of coarctation of the aorta

Answer 8

1. CXR: rib notching - “3” sign
2. ECG: LVH
3. Angiogram: gold standard, CT scan

Question 9

Management of coarctation of the aorta

Answer 9

Surgical correction

Balloon angioplasty, prostaglandin E preoperatively

Question 10

Continuous machinery murmur loudest at pulmonic area

Answer 10

Patent ductus arteriosus

Question 11

Bounding pulses, wide pulse pressure

Answer 11

Patent ductus arteriosus

Question 12

Pulmonary hypertension - left to right shunt switches and become right to left shunt (cyanotic). Normal hands with cyanotic lower extremities (clubbed, blue toes)

Answer 12

Eisenmenger’s Syndrome
Patent Ductus Arteriosus
Ventricular Septal Defect
Tetralogy of Fallot

Question 13

Diagnosis of patent ductus arteriosus

Answer 13

1. CXR: normal or cardiomegaly
2. ECG: LVH, left atrial enlargement
3. Echo: gold standard

Question 14

Management of patent ductus arteriosus

Answer 14

IV indomethacin - closes

Surgical correction if fails

Question 15

Most common cyanotic heart disease overall

Answer 15

Tetralogy of Fallot

Question 16

Tet spells - period of episodes of cyanosis relieved with squatting or putting an infant’s knees to its chest

Answer 16

Tetralogy of Fallot

Question 17

4 components of tetralogy of fallot

Answer 17

1. RV outflow obstruction - pulmonary artery stenosis
2. RV hypertrophy
3. VSD
4. Overriding aorta

Question 18

Harsh holosystolic murmur at left upper sternal border, right ventricular heave

Answer 18

Tetralogy of fallot

Question 19

Diagnosis of tetralogy of fallot

Answer 19

1. CXR: boot shaped heart
2. ECG: right ventricular hypertrophy
3. Echo - gold standard

Question 20

Management of tetralogy of fallot

Answer 20

Surgical repair performed in first 4-12 months of life

Question 21

Most common type of congenital heart disease

Answer 21

Ventricular septal defect

Question 22

Most common type of ventricular septal defect

Answer 22

Perimembranous

Question 23

Loud high-pitched harsh, holosystolic murmur at the lower left sternal border

Answer 23

Ventricular septal defect

Question 24

Diagnosis of ventricular septal defect

Answer 24

1. CXR: RV hypertrophy
2. Echo: preferred over cath
3. ECG: OVH, RAE/LAE
4. MRI: only if echo nondiagnostic
5. Cardiac cath - if other tests fail

Question 25

Management of ventricular septal defect

Answer 25

Most will close spontaneously within 10 years Restrictive VSD (left > right pressure) associated with good prognosis Surgery - patch closure

Question 26

Acute autoimmune inflammatory multi-systemic illness mainly affecting children 5-15 y/o

Answer 26

Acute rheumatic fever

Question 27

Complications of rheumatic fever

Answer 27

Cardiac | Rheumatic valvular disease - mitral MC, then aortic

Question 28

Diagnosis of rheumatic fever

Answer 28

Jones criteria

Question 29

Signs/symptoms of rheumatic fever

Answer 29

1. Polyarthritis 2. Active carditis 3. Erythema marginatum (rash)

Question 30

Management of rheumatic fever

Answer 30

1. Aspirin 2. Penicillin G +/- corticosteroids if severe and with carditis

Question 31

Warm + CREAM | Kawasaki Disease

Answer 31

Fever + 4 of the following: Conjunctivitis Rash Extremity changes: edema, erythema of palms and soles Adenopathy Mucous membranes: pharyngeal erythema, lip swelling and fissures, strawberry tongue

Question 32

Diagnosis of Kawasaki Disease

Answer 32

``` ESR/CRP elevated Leukocytosis Increased platelets Normochromic normocytic anemia Echo and angiography needed if heart involvement ```

Question 33

Management of Kawasaki Disease

Answer 33

IV immunoglobulin | High dose aspirin

Question 34

Most common initial complaint of hypertrophic cardiomyopathy

Answer 34

Dyspnea

Question 35

Harsh systolic crescendo-decrescendo murmur at lower left sternal border

Answer 35

Hypertrophic cardiomyopathy

Question 36

HCM will have decreased murmur intensity with:

Answer 36

Squatting, supine, handgrip

Question 37

HCM with have increased murmur intensity with:

Answer 37

Valsalva and standing, exertion

Question 38

Diagnosis of HCM

Answer 38

Echo | ECG: LVH

Question 39

Management of HCM

Answer 39

Avoid exertion, implantable defibrillator Beta blockers Surgical: myomectomy, EtOH ablation