Congenital Heart Disease 🫀 Flashcards by Fatima Meftah

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

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

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

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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

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

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Most common congenital heart anomaly in Turner syndrome

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

Bicuspid aortic valve

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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

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

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

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

TOF
DiGeorge syndrome chromosome 22q11
- TOF
- TA

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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

Mitral valve prolapse
Marfan syndrome

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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

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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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

Diastolic function

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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

Hypertrophic cardiomyopathy

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

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Best option regarding treatment of HOCM:

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

ß-blocker

Tx of HOCM:
ß-b , CCB

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

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

Ankle edema

In infants: sacral edema
In walking child: LL edema

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Which of the following decrease mortality in heart failure ?

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

ACE-i

ß-blockers
MRAs
Empagloflozine

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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

Need more caloric

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

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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

VSD

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

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Asymptomatic child with 2 mm VSD
Most appropriate action:

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

Close follow up

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

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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VSD’s that most likely to close spontaneously:

▪️ <5 mm
▪️ Muscular > perimembranous

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ASD’s that most likely to close spontaneously:

▪️<8mm
▪️Secundum > primum

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

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

Follow-up

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

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

PDA

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

Indomethacin

PDA closure
Preterm: NSAID
Term infant: Surgical

Which of the following CHD present in neonates?

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

TGA
TOF cyanosis later (4-6 months)

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

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

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

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

Nitroglycerin

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

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

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

**Prostaglandins E1** Most likely cyanotic heart disease (no response to 100% O2) 🔹Cyanotic = PG (to keep PDA open) 🔹Noncyanotic = diuretics

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

**Mother with GDM**

Which of the following cyanotic CHD with normal pulmonary blood flow A. TOF B. TGA C. Pulmonary atresia D. Tricuspid atresia

**TGA** Cyanotic CHD with RV obstruction & 🔻 pulmonary flow: ▪️TOF ▪️Pulmonary atresia ▪️ Tricuspid atresia Cyanotic CHD with no obstruction & 🟢 normal pulmonary flow: ▪️TGA ▪️TAPVR

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 newborn with truncus arteriosus**

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

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

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

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

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

**Aspirin** No role for NSAID or IVIg in rheumatic carditis ‼️

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

**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

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

**5 years**

5 yo with HF and femoral artery looks like a pistol shot Likely cause: A. MR B. AR C. AS D. MS

**Aortic regurgitation**

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

**Blood culture** IE best timing for culture during fever

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

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

CHD Least associated with IE: A. ASD B. PDA C. VSD E. TOF

**ASD**

Who will need antibiotic prophylaxis against IE: A. Dental procedure B. Cessarain section C. GIT endoscopy D. Peritoneal dialysis catheter insertion

**Dental procedure** Any procedure above diaphragm / infection

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

**Mother + Anti Ro & Anti La** Neonatal lupus

5 yo with HR: 254 bpm, hemodynamically stable First line management: A. Ice packing B. Carotid sinus massage C. Valsava maneuver D. Adenosine

**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

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

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

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

**Lithium** WPW is common in Ebstien anomaly

Delta wave is a sign of A. SVT B. WPW C. Brugada stndrome D. Sick sinus syndrome

**WPW** *the qs was an ECG pic*

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

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

5 yo asymptomatic, found to have murmur ECG showed RBBB: A. PDA B. ASD C. VSD D. AV canal malformation

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