Congenital Heart Disease Flashcards
A 2 week old girl, Amelia, is brought by ambulance to the emergency department after having quite suddenly gone a pale, grey colour with poor circulation, low tone, poor eye contact and a central capillary refill of 5 seconds. She has rapid shallow breathing and tachycardia and it is difficult to feel any pulses. Oxygen saturation is 85%. A blood culture has been taken and IV antibiotics started for the possibility of sepsis.
Besides sepsis which other problem needs to be considered urgently?
Question 1Select one:
a.
Coarctation of aorta with acute ductus closure.
b.
Ventricular septal defect decompensating.
c.
Transposition of the great arteries without shunt.
d.
Tetralogy of Fallot with a cyanotic spell.
Coarctation of aorta with acute ductus closure.
Pulses would be present in teratory of fallot with cyanotic spell.
duct closes around a few weeks of life
A 7-month old boy, Max, arrives at the ED by ambulance after he suddenly went limp and was a purple dusky colour all over. This lasted for 2 minutes, after which he slowly recovered. He was a full term infant, born at home with no complications, and fully breast fed. He was admitted with bronchiolitis briefly at 3 weeks of age and had desaturation noted initially at 75% but as he improved clinically the oximetry monitoring was discontinued.
When you examine Max you find he looks alert and well. He is a bit bluish in the tongue, the nail beds and the conjunctivae and you confirm this with a pulse oximetry reading of 76%. The capillary refill time is normal. He has no tachypnea or tachycardia. There is a loud ejection systolic murmur. Oxygen supplementation is commenced at 6L/minute but overnight monitoring shows his oxygen saturation remains at about 76-77% despite this.
What is Max’s most likely diagnosis?
Select one:
a.
Transposition of great arteries
b.
Ventricular septal defect
c.
Tetralogy of Fallot
d.
Coarctation of the aorta
Tetralogy of Fallot
A 2 day-old infant looks bluer in the lower body than in the face. A murmur can be heard over the back on the left. He is otherwise well and asymptomatic. You are concerned about coarctation of the aorta.
What bedside test in the neonatal period can be used to screen for coarctation?
Question 3Select one:
a.
R arm & foot oximetry
b.
Chest radiograph
c.
Electrocardiogram
d.
Arterial gas analysis
R arm & foot oximetry
What murmur is characteristic of an Atrial Septal Defect and can be heard in childhood?
Question 4Select one:
a.
Pansystolic apical murmur
b.
Pulmonary flow murmur
c.
Continuous rough murmur
d.
Early diastolic murmur
Pulmonary flow murmur
Same thing as ejection systolic
A baby boy, Rory, is born at 30-weeks gestation and develops respiratory distress with grunting and intermittent desaturations. Continuous positive airway pressure support (CPAP) at a pressure of 10 cm with air is commenced, but there are periods of brief apnea with desaturations.
On day 2, a new increase in breathing rate and heart rate are observed requiring an increase in CPAP pressure. A harsh murmur through systole and early diastole is heard just below the left clavicle. The blood pressure is 100/25 and he has a pulse rate of 160/min. His femoral pulses are bounding, and you can feel his radial and brachial pulses very easily.
What is the most likely diagnosis?
Question 5Select one:
a.
Transposition great arteries
b.
Patent ductus arteriosus
c.
Ventricular septal defect
d.
Coarctation of the aorta
Patent ductus arteriosus
A male infant who is 24 hours of age is noted to be severely cyanosed with pulse oximetry reading of 65% in air. He looks generally well with no increased work of breathing although he has mild tachycardia and tachypnea. A capillary gas measurement shows a metabolic acidosis with high lactate. You give 100% oxygen but the pulse oximetry reading remains below 70%.
What diagnosis should you consider?
Question 6Select one:
a.
Ventricular Septal Defect
b.
Coarctation of the aorta
c.
Patent Ductus Arteriosus
d.
Transposition of Great Arteries
Transposition of Great Arteries
Joanna, a previously well girl aged 14, comes to your surgery because in the last few months she has been very tired, lacking in energy and has difficulty keeping up in fitness class. On examination you hear an ejection systolic heart murmur at the upper sternum. The second heart sound is very obviously split and equally on inspiration and expiration. There is no thrill and no sign of heart failure. Joanna has no cyanosis or clubbing. What cardiac condition would explain these signs and symptoms?
Question 7Select one:
a.
Atrial septal defect with a left to right shunt
b.
Mild stenosis of the pulmonic valve
c.
Innocent flow murmur occurring with infection
d.
Tetralogy of Fallot with a right to left shunt
Atrial septal defect with a left to right shunt
A baby boy, Kai, is seen at 4 weeks of age due to concerns about rapid breathing and poor weight gain. His mother comments that he has been breast-feeding slowly and tires easily with feeding—to the extent he gets sweat on his forehead. He has had two respiratory infections. He has not gained weight in the last 2 weeks.
Examination reveals a rather thin, pink, baby with respiratory rate 60/min and subcostal indrawing.
The hands are cold, pale and sweaty.
Auscultation of the chest is clear, and he has increased precordial pulsation, a heart rate of 160/minute, and a pansystolic murmur at the lower left sternal edge.
His liver is palpable 1 cm below the costal margin. The femoral pulses are palpable.
What diagnosis should be considered, taking into account the above symptoms and signs?
Question 8Select one:
a.
Bacterial pneumonia
b.
Ventricular septal defect
c.
RSV bronchiolitis
d.
Tetralogy of Fallot
VSD
Liam is a 2 week old baby just diagnosed with Trisomy 21. He has become increasingly breathless and tachypneic, with difficulty feeding, and a very active precordial impulse. His oxygen saturation is about 90%. No murmur is heard. He has liver enlargement. A chest x-ray shows a very large heart and blood vessels easily visible right out to the lung peripheries. ECG shows an axis of -50 degrees.
What cardiac condition, most commonly found in Trisomy 21, would cause these findings?
Question 9Select one:
a.
Patent ductus arteriosus
b.
Tetralogy of Fallot
c.
Transposition of great arteries
d.
Atrio-ventricular septal defect
AVSD
