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Peds 👶🏻 > Congenital Heart Disease 🫀 > Flashcards

Congenital Heart Disease 🫀 Flashcards

1
Q

A girl found to have radio-femoral delay
most likely cause:

A. Coarctation of aorta
B. PDA
C. ASD
D. VSD

A

Coarctation of aorta
- Radio-femoral delay
- High BP upper extremity , Low BP lower extremity
- rib notching CXR

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2
Q

A child with accidental discover of heart murmur, Severe AS on Echo , Asymptomatic
Best action:

A. Annual follow up
B. Aortic valve replacement
C. ACE-i
D. Balloon dilation

A

Balloon dilation
AS:
-Mild: systolic gradient <25 = follow up
-Moderate: 25-50 = ?
-Severe: >50 mmHg = balloon dilation » AV replacement

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3
Q

Most common congenital heart anomaly in Turner syndrome

A. Coarctation of Ao
B. Bicuspid AV
C. TOF
D. Mitral valve prolapse

A

Bicuspid aortic valve

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4
Q

A mother delivered and her baby found to have absent red reflex and PDA
Most likely cause:

A. Gestational DM
B. Maternal Hypertension
C. Congenital Rubella
D. Lithium

A

Congenital Rubella syndrome
🔸 Cataract
🔸 Deafness
🔸 Blue berry muffin rash
🔸 PDA, pulmonary stenosis
🔸 Endocrinopathy like DM

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5
Q

5 years old with developmental delay, recurrent infection, recurrent tetany
Most common congenital anomaly:

A. TOF
B. TGA
C. ASD
D. VSD

A

TOF
DiGeorge syndrome chromosome 22q11
- TOF
- TA

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6
Q

A child with tall sature, pecus excvaum lens dislocation,
Most common congenital heart anomaly:

A. TOF
B. Mitral valve prolapse
C. TGA
D. Coarctation of aorta

A

Mitral valve prolapse
Marfan syndrome

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7
Q

6 yo child came for pre-school checkup found to have grade iii heart murmur along the sternal border, “no specific timing or location of the murmur provided”, no thrill, the murmur accentuated with supine position, Dx:

A. Still’s mirmur
B. VSD
C. ASD
D. Aortic stenosis

A

Still’s murmur

Innocent murmur
# short
# soft
# healthy child 3-6 yr
# no radiation
# change with posture
# no thrill (grade i/ii/iii)

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8
Q

A child with hypertrophic obstructive cardiomyopathy
The following will be affected in this condition:

A. Systolic function
B. Diastolic function
C. Venous return
D. Mitral valve

A

Diastolic function

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9
Q

A young basketball player suddenly collapsed and found to have weak & jerky carotid pulse. Mist likely cause:

A. Dilated CMP
B. Hypertrophic CMP
C. Restrictive CMP
D. Mitral valve prolapse

A

Hypertrophic cardiomyopathy

🗒️ Etiologies :
- genetic (AD)
- glycogen storage disease
- infant of diabetic mother

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10
Q

Best option regarding treatment of HOCM:

A. ACE-i
B. Digixin
C. ß-blocker
D. Hydralazine

A

ß-blocker

Tx of HOCM:
ß-b , CCB

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11
Q

All the following are symptoms of heart failure in infants except:

A. Slow feeding
B. Ankle edema
C. Hepatomegaly
D. Lung crepitation

A

Ankle edema

In infants: sacral edema
In walking child: LL edema

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12
Q

Which of the following decrease mortality in heart failure ?

A. Diuretics
B. ACE-i
C. Digoxin
D. CCB

A

ACE-i

ß-blockers
MRAs
Empagloflozine

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13
Q

Which of the following is true regarding caloric requirement in children with congenital heart disease vs normal population?

A. Need more caloric
B. Need the same caloric
C. Need less caloric
D. Need more fluid

A

Need more caloric

  • High caloric diet (150 kcal/kg)
  • immunization
  • RSV immunoglobulin prophylaxis
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14
Q

7 months old, poor feeding, O/E:
Hyperactive pericordium, loud S2, pansystolic murmur 3/6 @ LLSB

A. Small PDA
B. Large ASD
C. AR
D. MD
E. Large VSD

A

VSD

PDA: machinery continuous murmur
ASD: fixed splitting
AR: diastolic decreacendo murmur
MR: pansystolic @ apex (mitral area)
Coarctation: systolic @ LUSB

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15
Q

Asymptomatic child with 2 mm VSD
Most appropriate action:

A. Cathater
B. Surgery
C. Close follow up
D. Prophylaxis antibiotics before dental procedure

A

Close follow up

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16
Q

Which of the following indicates large VSD
A. Normal growth
B. Harsh murmur
C. Loud S2
D. Pansystolic murmur radiates to axilla

A

Loud S2

🔹Small VSD: ASx, harsh murmur
🔹Large VAD: soft pansystolic murmur, mid-diastolic over Mitral area, systolic murmur over Aortic area
🔺 Pulmonary blood pressure = PAH ➡️ Loud S2

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17
Q

VSD’s that most likely to close spontaneously:

A

▪️ <5 mm
▪️ Muscular > perimembranous

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18
Q

ASD’s that most likely to close spontaneously:

A

▪️<8mm
▪️Secundum > primum

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19
Q

On routine checkup a child found to have 5mm ASD. He is healthy

A. Surgery
B. Follow-up
C. Catheter
D. Antibiotic prophylaxis

A

Follow-up

20
Q

Preterm baby delivered and found to have HF and continuous machinery murmur
Most likely Dx:

A. Infective Endocarditis
B. TOF
C. PDA
D. VSD

A

PDA

21
Q

GA: 30 weeks delivered
At age of 5 days, he is found to have gallop and hepatomegaly. You found continuous machinery murmur. Best Tx:

A. Prostaglandin
B. Indomethacin
C. Digoxin
D. Antibiotic
E. Surgical closure

A

Indomethacin

PDA closure
Preterm: NSAID
Term infant: Surgical

22
Q

Which of the following CHD present in neonates?

A. VSD
B. Coarctation of aorta
C. TGA
D. TOF

A

TGA
TOF cyanosis later (4-6 months)

Neonate with cyanosis: 100% oxygen
✅ respond: lung disease
❌ no response: CHD

23
Q

5 yo girl TOF with cyanotic spells
All are useful for management except:

A. Squatting position
B. Oxygen
C. Morphine
D. Sodium bicarb
E. Diuretics

A

Diuretics❌❌
🔻 BP and increase Right to Left shunt

Hypoxic spells:
O: oxygen
S: sodium bicarb
A: a-agonist
M: morphine
A: adrenergic ß-blocker
H: hydration IVF

24
Q

Which of the following not given in patients with cyanotic spills in TOF?

A. Phenylephrine
B. Crystalloid solution
C. IV morphine
D. Nitroglycerin
E. Knee-chest position

A

Nitroglycerin

25
Q

Child with history of TOF correction now present with LLSB systolic murmur that increase with inspiration

A. Pulmonary regurgitation
B. Tricuspid regurgitation
C. Aortic stenosis
D. Mitral stenosis

A

Tricuspid regurgitation

RV obstruction, TR & PR are common following surgical operation after TOF
🔺 with inspiration = TR or PR
TR: systolic
PR: diastolic

26
Q

Neonate developed cyanosis in 2nd or 3rd days after delivery. No response to 100% oxygen
Best management is:

A. NSAID
B. Steroid
C. Prostaglandin E1
D. Furosamide

A

Prostaglandins E1

Most likely cyanotic heart disease (no response to 100% O2)
🔹Cyanotic = PG (to keep PDA open)
🔹Noncyanotic = diuretics

27
Q

Baby delivered with cyanosis and found to have TGA
Which might be contributing factor?

A. Mother with pre eclampsia
B. Mother with GDM
C. Mother with fever
D. Mother taking NSAIDs

A

Mother with GDM

28
Q

Which of the following cyanotic CHD with normal pulmonary blood flow

A. TOF
B. TGA
C. Pulmonary atresia
D. Tricuspid atresia

A

TGA

Cyanotic CHD with RV obstruction & 🔻 pulmonary flow:
▪️TOF
▪️Pulmonary atresia
▪️ Tricuspid atresia

Cyanotic CHD with no obstruction & 🟢 normal pulmonary flow:
▪️TGA
▪️TAPVR

29
Q

Which of the following would exhibit cyanosis?

A. 18 months with TOF and Hb 4.5
B. 6 years with coarctation of aorta
C. 18 months with muscular VSD
D. A newborn with truncus arteriosus

A

** A newborn with truncus arteriosus**

30
Q

5 years old child came with arthritis and macular rash that increase after hot shower

A. Systemic JIA
B. Rheumatic fever
C. Brucellosis
D. SLE

A

Rheumatic fever

J❤️NES criteria
J for joint
E for Erythema marginatum (inc with hot shower)

31
Q

Which of the following are enough to diagnose RHD ?

A. Arthritis, arthralgia, fever
B. Carditis, prolong PR, elevated ESR
C. Subcutaneous nodules, carditis
D. Arthritis, elevated ESR

A

Subcutaneous nodules, carditis

2 major
1 major, 2 minors
# if you have carditis dont count prolonged PR as criteria

32
Q

6 yo girl with rheumatic carditis and HF
Which of the following not essential in management?

A. Furosemide
B. Aspirin
C. Penicillin
D. Captopril
E. Low salt diet

A

Aspirin
No role for NSAID or IVIg in rheumatic carditis ‼️

33
Q

A 6 years old petient with rheumatic carditis without valvular lesion
How long you will give prophylaxis?

A. 5 years
B. 10 years
C. 15 years
D. 20 years

A

10 years

🚫❤️ RF : 5 years or till age 21
RHD - valvular : 10 years or till age 21
RHD + valvular : 10 years or till age 40

34
Q

A 17 years ild with Rheumatic arthritis
How long you will give prophylaxis?

A. 5 years
B. 10 years
C. 15 years
D. 20 years

A

5 years

35
Q

5 yo with HF and femoral artery looks like a pistol shot
Likely cause:

A. MR
B. AR
C. AS
D. MS

A

Aortic regurgitation

36
Q

10 yo boy known for VSD present with fever. Last week done dental extraction
Most important investigation:

A. CRP
B. Blood culture
C. Echo
D. ECG
E. Urine culture

A

Blood culture
IE best timing for culture during fever

37
Q

Which of the following will not need antibiotic prophylaxis for IE

A. Cardiac transplant with valve regurgitation
B. Previous history of IE
C. Mitral valve prolapse
D. Unrepaired TOF
E. Prosthetic valve

A

MVP

A. المرتجع
B. ذو التاريخ المسبق
D. المزرق
E. المصطنع

38
Q

CHD Least associated with IE:

A. ASD
B. PDA
C. VSD
E. TOF

A

ASD

39
Q

Who will need antibiotic prophylaxis against IE:

A. Dental procedure
B. Cessarain section
C. GIT endoscopy
D. Peritoneal dialysis catheter insertion

A

Dental procedure
Any procedure above diaphragm / infection

40
Q

A baby delivered with heart block. Which of the following most likely cause:

A. Gestational diabetes
B. Mother + Anti Ro & Anti La
C. Prolonged ROM
D. Mother use of ACE-i

A

Mother + Anti Ro & Anti La
Neonatal lupus

41
Q

5 yo with HR: 254 bpm, hemodynamically stable
First line management:

A. Ice packing
B. Carotid sinus massage
C. Valsava maneuver
D. Adenosine

A

Valsava maneuver

SVT: HR >220 infant or > 180 older children
✅ Hemodynamically stable
👶🏻 infant <1 yr: ice packing » adenosin » 2nd dose
🧒🏻 older child: valsava » adenosin » 2nd dose

42
Q

9 mo with HR: 250 bpm
BP 59/30 next best step:

A. Ice packing
B. Carotid massage
C. Adenosine
D. Synchronized cardioversion of 1j / kg

A

Synchronized cardioversion

SVT: HR >220 infant or > 180 older children
‼️ Hemodynamically unstable
Synchronized cardioversion of 1j / kg

43
Q

A baby delivered with cyanosis and found to have enlarged heart and oliogemic lungs. Echo showed Ebstien anomaly.
What might be the cause?

A. Mother taking NSAID
B. Mother with GDM
C. Mother known HTN
D. Mother taking lithium

A

Lithium
WPW is common in Ebstien anomaly

44
Q

Delta wave is a sign of

A. SVT
B. WPW
C. Brugada stndrome
D. Sick sinus syndrome

A

WPW
the qs was an ECG pic

45
Q

A patient known TOF and you read his ECG most likely will find:

A. Right axis
B. Left axis
C. Superior axis
D. Inferior axis

A

Right axis

Rt axis = RVH. RBBB PS PAH. Wide split
Lt axis = LVH. LBBB AS HTN. Paradoxical
…
Right axis normal in neonates

46
Q

5 yo asymptomatic, found to have murmur
ECG showed RBBB:

A. PDA
B. ASD
C. VSD
D. AV canal malformation

A

ASD

RBBB (RVH) … LBBB (LVH) … Superior axis
ASD VSD AV canal
TOF PDA Tricuspid atresia
CLD
Neonate ✅

Peds 👶🏻 (16 decks)

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