Exam Questions - cardiology

Question 1

2008/1 QUESTION 14 The most significant change in auscultatory findings during a cyanotic spell in an infant with tetralogy of Fallot is that the: A. ejection systolic murmur becomes louder. B. ejection systolic murmur becomes softer. C. pansystolic murmur becomes louder. D. pansystolic murmur becomes softer. E. second heart sound becomes more widely split.

Answer 1

TET’s spells: Findings during paroxysmal hyper cyanotic attacks may include: - acute increase and progressively worsening cyanosis - MURMUR DISAPPEARS or DECREASES in intensity as flow across the RVOT diminishes - severe spells may progress to convulsions of hemiparesis therefore the answer that is most correct is B.

Question 2

2008/1 QUESTION 33 A six-month-old child undergoes cardiac catheterisation. The oxygen saturations obtained in room air during the procedure are as follows: Superior vena cava 75% Right atrium 75% Inferior vena cava 75% Right ventricle 87% Main pulmonary artery 87% Left ventricle 99% Aorta 99% These findings are most consistent with a diagnosis of: A. atrial septal defect. B. atrioventricular septal defect. C. patent ductus arteriosus. D. tetralogy of Fallot. E. ventricular septal defect.

Answer 2

Both a VSD and an ASD will have increased SpO2 in the right ventricle and right PA, without affecting the other parts of the heart. However a VSD is more common than an ASD. E.

Question 3

2008/1 QUESTION 53 The arterial blood pressure trace of an unwell one-year-old child is shown below. The child has a one week history of low grade fever with viral symptoms. At presentation the child is tachycardic and tachypnoeic with poor peripheral perfusion. drop in blood pressure with inspiration of ~10mmHg. The most likely diagnosis is: A. cardiac tamponade. B. coarctation of aorta. C. dilated cardiomyopathy. D. septic shock. E. viral myocarditis.

Answer 3

A. Cardiac tamponade - pulsus paradoxus: drop in blood pressure of >10mmHg with inspiration - associated tachycardia and tachypnoea

Question 4

2008/2 QUESTION 7 A five-year-old boy is diagnosed with Duchenne muscular dystrophy. At the time of diagnosis he has a normal cardiac examination, electrocardiogram (ECG), echocardiogram and 24-hour Holter monitor. The cardiac complication most likely to develop in this child is: A. dilated cardiomyopathy. B. hypertrophic cardiomyopathy. C. mitral valve prolapse. D. supraventricular arrhythmias. E. ventricular arrhythmias.

Answer 4

A. Dilated Cardiomyopathy Duchenne muscular dystrophy (DMD) is an X-linked recessive disease that presents in boys age 2-5 years (or girls with turners syndrome). Relentlessly progressive • Delayed motor milestones • Difficulty running • Increasing falls • Enlarged calves • (Associated features of intellectual disability, learning disorders, autism and ADHD may present.) • Dilated Cardiomyopathy o Associated heart failure and fatal arrhythmias o Resting tachycardia and decreased heart rate variability o Diastolic disfunction o Myocardial strain

Question 5

2008/2 QUESTION 15 A term neonate presents with severe cyanosis from the time of delivery. The diagnosis of obstructed total anomalous pulmonary venous drainage is confirmed by echocardiograph. The intervention which would be most likely to adversely affect the patient’s clinical state would be: A. dobutamine. B. dopamine. C. frusemide. D. oxygen. E. prostaglandin E1.

Answer 5

TAPVR - cyanotic heart lesions - the left atrium is isolated from the systemic circulation - the pulmonary veins drain into the venous system - inferiorly, superiorly or mixed. - paediatric cardiac surgical emergency as prostaglandin therapy is usually not effective - incompatibly with life unless a PFO or ASD is present

Question 6

QUESTION 21

A four-week-old infant is referred for assessment as she has not yet regained her birth weight. Her mother reports that breast feeding is not well established. The infant is not clinically cyanosed, but is mildly tachypnoeic with mild hepatomegaly. Pulses are normal. Heart sounds are normal. There is a grade 3/6 systolic murmur. The electrocardiogram (ECG) is shown below.

This clinical scenario would be most consistent with the diagnosis of:

atrioventricular septal defect.

patent ductus arteriosus.

tetralogy of Fallot.

truncus arteriosus.

ventricular septal defect.