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Peds I > Exam 3: Cardio > Flashcards

Exam 3: Cardio Flashcards

1
Q

When there is a palpable thrill on exam, what is the lowest grade murmur that patient can have?

A

Needs to be at least a grade 4

Grade 1, 2, and 3 have no palpable thrill

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2
Q

What is the gold standard of pediatric cardiology diagnostic tools?

A

Echocardiogram (TEE and TTE)

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3
Q

What is the most common innocent murmur of childhood?

A

Still murmur

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4
Q

What kind of murmur has musical or vibratory quality best heard at the LLSB, and is loudest when supine and diminishes with inspiration or sitting?

A

Still murmur

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5
Q

What is the most common murmur in older children and adults?

A

Pulmonary flow murmur

  • This murmur does not occur in infancy
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6
Q

What kind of murmur sounds like a musical hum best heard at the R and L USB that is louder in diastole and while sitting with the head extended, but disappears with turning the head or laying supine?

A

Venous hum -Innocent murmur

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7
Q

What are the 3 kind of innocent murmurs?

A

Still murmur, pulmonary flow, and venous hum

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8
Q

What are the acyanotic congenital heart diseases?

A

VSD, ASD, patent ductus arteriosus, and coarctation of the aorta

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9
Q

What are the cyanotic congenital heart diseases?

A

-Tetraology of fallot, transposition of the great arteries, tricuspid atresia, truncus arteriosus, total anomalous Pulmonary venous return, and hypoplastic left heart syndrome

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10
Q

What is the most common congenital heart defect?

A

VSD

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11
Q

What does VSD sound like on auscultation?

A

Harsh, holosystolic murmur at the LLSB

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12
Q

What are the diagnostic tests for VSD?

A

ECHO, EKG, and CXR

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13
Q

What are the treatments for VSD?

A

1) wait if asymptomatic, it may spontaneously close
2) treat CHD with diuretics, ace inhibitors, possibly digoxin
3) Surgery if failure of medical management

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14
Q

What is the most common location fo ASD?

A

Ostium secundum

** may also be located at ostium primum or sinus venosus

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15
Q

What is the common PE finding with ASD?

A

-Fixed and widely split S2 at pulmonary area

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16
Q

How is ASD diagnosed?

A

ECHO

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17
Q

What kind of ASD is often associated with other defects?

A

ASD of the ostium primum

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18
Q

When is Patent Ductus arteriosus (PDA) commonly seen?

A

Premature infants, more often in females, and maternal rubella

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19
Q

What is the normal direction of flow in PDA? What can change this?

A
  • normally L-> R shunting occurs with normal pulmonary vascular resistance.
  • Eisenmerger syndrome: shunt can reverse and become R-L if high pulmonary pressures causing cyanosis
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20
Q

What are the common physical exam findings with PDA?

A
  • Continuous machinery like murmur

- Wide pulse pressure with bounding pulses

21
Q

What do you give to keep PDA open?

A

IV prostaglandin E1

22
Q

What do you give to close PDA?

A

IV indomethacin

23
Q

What is coarctation of the aorta?

A

Narrowing of the aortic arch, usually in the proximal descending aorta near the takeoff of the let subclavian artery and the ductus arteriosus

24
Q

What syndrome is coarctation commonly associated with?

A

Turner syndrome

  • Also seen in children with unexplained hypertension
25
Q

What is the typical presentation of coarctation of the aorta?

A
  • Absent or decreased femoral pulses

- UE SBP >20 higher than LE SBP

26
Q

How is Coarctation diagnosed?

A

CXR (Figure 3 sign and inferior rib notching)

27
Q

What is the treatment for coarctation?

A

Surgery

28
Q

What are the 4 components of tetralogy of fallot?

A

1) RV hypertrophy
2) VSD
3) Overriding aorta
4) RV outflow obstruction

29
Q

What is the most common cyanotic CHD?

A

Tetralogy of fallot

30
Q

What is the common presentation of tetralogy of fallot?

A

-“Tet Spells” with worsening cyanosis, alterations in consciousness, often occurring with crying/feeding, and starts around 4-6 months of age

31
Q

What do toddlers frequently do to relieve tet spells?

A

They squat to relieve dyspnea (increases systemic vascular resistance)

32
Q

What is commonly seen on CXR with tetralogy of fallot?

A

“Boot shaped” heart

33
Q

What is heart on auscultation of a patient with tetralogy of fallot?

A

-Harsh systolic ejection crescendo decrescendo murmur at ULSB

34
Q

What is transposition of the great arteries?

A

Anatomic malformation where aorta comes off RV and PA comes off LV

35
Q

What is the clinical presentation seen with transposition of the great arteries?

A
  • Blue baby

- Profoundly cyanotic without Respiratory distress or significant murmur

36
Q

What is commonly seen on CXR with transposition of the great arteries?

A

“Egg on a string”

37
Q

How is transposition of the great arteries treated?

A
  • Cardiac Cath
  • Prostaglandin E1 administration to keep PDA
  • Surgery (4-7 days of age)
38
Q

What is tricuspid atresia?

A
  • Congential absence of tricuspid valve

- Very low survival rate if untreated

39
Q

What is the treatment of tricuspid atresia?

A
  • Prostaglandin E1 to keep PDA

- Surgery

40
Q

What is truncus arteriosus?

A

Aorta and PA fail to separate and a single artery arises from the heart
-VSD is always present

41
Q

What is heard on auscultation with truncus arteriosus?

A

Loud single S2 (Narrow split S2) with prominent ejection click

42
Q

What is total anomalous pulmonary venous return?

A

Pulmonary veins drain into the venous system so oxygen rich and poor blood mix in the right atrium

43
Q

What is hypoplasia of the left heart dependent upon for survival?

A

PDA

44
Q

What congenital heart defects is trisomy 21 commonly associated with?

A

Atriventricular septal defect, ToF, and PDA

45
Q

What congenital heart defects is fetal alcohol syndrome commonly associated with?

A

VSD and ASD

46
Q

What is the significant cardiac complication with Kawasaki disease?

A

Coronary artery aneurysms which may lead to myocardial ischemia or MI

47
Q

What is the leading cause of sudden cardiac death in young people?

A

Hypertrophic cardiomyopathy

48
Q

What finding is often diagnostic of hypertrophic cardiomyoapthy?

A

Presence of audible S4

Peds I (5 decks)

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