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Paediatric Cardiology > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

Cyanotic CHDs (6)

A

H+5Ts:

  • hypoplastic L heart syndrome
  • tetralogy of fallot
  • transposition of the great arteries
  • tricuspid and pulmonary atresia
  • total anomalous pulmonary venous connection
  • truncus arteriosus
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2
Q

Acyanotic CHD (6)

A

VC PAPA:

  • VSD
  • coarctation of the aorta
  • PDA
  • ASD
  • pulmonary stenosis
  • aortic stenosis
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3
Q

general presentation of CHD (3)

A

often sweaty
breathlessness often during feeds
fail to thrive due to high metabolic demand

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4
Q

Features of osteum secundum ASD (4)

A

higher in atrium
often asymptomatic till adulthood
3 times more common in girls
ECG shows RBBB w. RAD

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5
Q

Features of osteum primum ASD (4)

A

lower in atrium
also affects AV valves>valve incompetence
common in Down’s
ECG shows RBBB w. LAD

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6
Q

Features of severe osteum primum defect (4)

A

breathlessness
recurrent chest infections
pulmonary HTN
heart failure

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7
Q

signs of ASD (3)

A

ejection systolic murmur loudest in pulmonary region
fixed, widely split s2
partial AVSD>pansystolic murmur at apex

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8
Q

complications of ASD (2)

A

Eisenmenger’s

paradoxical emboli

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9
Q

Ix in ASD (3)

A

CXR: enlarged right side, enlarged pulmonary vessels (pulmonary plethora)
ECG: RBBB+LAD(primum)/RAD (secundum)
Echo is diagnostic

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10
Q

Mx of primum and secundum defects (2)

A

secundum: insert device via cardiac catheter
primum: surgical closure by 3yrs.

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11
Q

Sx, signs, Ix and Rx of small VSDs (6)

A 
asymptomatic
signs: loud pansystolic murmur in tricuspid region, quiet p2
CXR and ECG normal
Echo is diagnostic
should close spontaneously
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12
Q

symptoms and signs of large VSDs (5)

A 
heart failure+SOB in first wk of life
recurrent chest infections
quiet/absent pansystolic murmur
loud p2
pulmonary HTN
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13
Q

Ix findings in large VSDs (6)

A 
CXR:
-Cardiomegaly
-engorged pulmonary arteries
-increased pulmonary vascular markings
-pulmonary oedema
ECG shows biventricular hypertrophy
echo is diagnostic
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14
Q

Mx of large VSDs (2)

A

diuretics for HF; most close spontaneously by 1yr

surgical closure if large or not controlled with diuretics by 3mo due to risk of Eisenmenger’s

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15
Q

features of PDA (3)

A

ductus open 12mo after due date
blood flows from aorta to pulmonary artery
in womb, ductus is maintained by low paO2 and PGE from the placenta

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16
Q

RFs for PDA (4)

A

Down’s
altitude
prematurity
rubella

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17
Q

Features of PDA (5)

A

continuous machinery murmur below left clavicle
raised pulse pressure
collapsing/bounding pulse
pulmonary HTN
may need ventilator support at birth which can be difficult to wean off

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18
Q

Ix for PDA (4)

A 
usually normal ECG and CXR
if severe, same as large VSD:
-CXR: cardiomegaly, pulmonary plethora etc
-ECG: biventricular hypertrophy
-echo is diagnostic
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19
Q

Rx of PDA (5)

A

most close spontaneously so don’t Rx unless 1yr (3mo for prem) or symptomatic.
Dexamethasone for prematurity
Indomethacin to close PDA in first 14d of life
diuretics to reduce preload
coil via cardiac cath/surgical closure

20
Q

coarctation of the aorta-common site, epidemiology and associations (4)

A

distal to left subclavian at the ductus
M>F
assoc. w. turner’s, bicuspid aortic valve, berry aneurysms and NF

21
Q

Features of pre-ductal coarctation (3)

A

symptomatic: sick infant w. absent femorals
arms pink and legs blue
right ventricle compensates and provides for systemic circulation via ductus> heart failure when it closes

22
Q

Mx of pre-ductal coarctation

A

give PGE infusion at Dx and transfer to cardiac centre

23
Q

Features of post-ductal coarctation (5)

A 
asymptomatic infant
HTN in arm
weak/absent femorals
mottled appearance of lower limb
left ventricular hypertrophy
24
Q

Mx of post-ductal coarctation

A

surgical resection: balloon dilatation or resection of segment

25
Q

Signs of coarctation

A

ejection systolic murmur; can heard between scapulae

26
Q

Ix for coarctation (4)

A

CXR: bilateral rib notching
ECG: RVH+RBBB in neonates and LVH in older kids
CT angiogram

27
Q

complications of coarctation (3)

A

LVH
aortic rupture
intracranial haemorrhage

28
Q

Rx of coarctation (2)

A

Furosemide

balloon dilatation, stenting and patching

29
Q

Causes of blue baby (4)

A

heart disease
lung disease
infection
polycythaemia

30
Q

how to differentiate between cardiac and pulmonary disease in blue baby

A

nitrogen washout test:

failure of PaO2 to rise above 15 in right radial artery after 10 mins on 100% O2.

31
Q

Mx of a blue baby and SEs (3)

A

start PGE infusion to maintain ductus
SEs: temperature, NEC and apnoea
may need Abx until sepsis is ruled out

32
Q

Tetralogy of Fallot (4)

A

overriding aorta
pulmonary stenosis
RVH
large VSD

33
Q

Associated condition of ToF

A

DiGeorge syndrome (absent thymus, cleft palate)

34
Q

presentation of ToF (6)

A

presents around 6mo
cyanosis
paroxysmal hypercyanotic spells: increasing cyanosis>white and floppy
clubbing
squatting after exercise
harsh ejection systolic murmur at left sternal edge

35
Q

Severity of ToF based on…

A

degree of pulmonary stenosis

36
Q

Ix for ToF (5)

A

CXR: boot shaped heart, decreased pulmonary vascular markings, RVH
ECG: RVH
echo shows cardinal features.

37
Q

Mx of ToF

A 
initially a PGE infusion and Blalock-Taussig shunt to maintain ductus
for hypercyanotic spells:
-sedation and analgesisa (morphine)
-propranolol
-bicarbonate to correct acidosis

will then require surgical correction at 6mo:

  • closure of VSD
  • pulmonary valve patching
38
Q

Features of TGA (2)

A

2 parallel circulations

not compatible w. life unless there’s also an ASD, VSD or PDA

39
Q

Presentation of TGA (2)

A

normally on 2nd day of life when ductus closes

cyanosis

40
Q

Ix for TGA

A

CXR shows egg-shaped heart

41
Q

Mx of TGA (3)

A

PGE infusion
balloon atrial septostomy to maintain foramen ovale
definitive surgery w/i 2wks of life.

42
Q

Features of complete AVSD (3)

A

most common CHD in down’s
cyanotic
presents w. SOB+cyanosis and signs of HF in first day of life

43
Q

when to Rx complete AVSD

A

at 3 months

44
Q

Features of tricuspid atresia (3)

A

no connection between RA and RV
venous blood flows through foramen ovale
pulmonary circulation dependant on the ductus

45
Q

Mx of tricuspid atresia (3)

A

PGE infusion
Blalock-Taussig shunt (pulm art>subclavian)
pulmonary artery banding

Paediatric Cardiology (1 decks)

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