Lec 12 : Acyanotic Congenital Heart Diseases (Pediatrics)

Question 1

Which of the following is not generally clinically considered as congenital heart defect?

a. bicuspid aortic valve
b. patent foramen ovale
c. atrial septal defect
d. A & B only
e. AOTA

Answer 1

d. A & B only

BAV and PFO are benign lesions.

Question 2

Patent ductus arteriosus and pulmonary stenosis are related to which known risk factor?

Answer 2

congenital rubella / maternal infection with rubella

Question 3

This chemical is found mostly on dermatologic products and is a known teratogen.

Answer 3

isotretinoin / retinoic acid

Question 4

A large percentage of congenital heart diseases are composed of

a. left to right shunts
b. obstructive lesions
c. right to left shunts
d. valvular heart diseases
e. NOTA

Answer 4

a. left to right shunts

40% L-R shunts
25% obstructive lesions
20% R-L shunts

Question 5

Ventricular septal defects generally presents with volume overload of what heart chamber?

Answer 5

left ventricle

The VSD shunts blood directly into the pulmonary circulation are returns to the LA and eventually the LV.

Question 6

This if the most common type of VSD.

Answer 6

perimembranous VSD

Question 7

T/F: A VSD with a harsh and loud murmur predisposes to LV overload and subsequent heart failure.

Answer 7

F

VSDs with harsh and loud murmur are generally small in size and are frequently asymptomatic.

Question 8

Characterize the murmur of a typical VSD.

Answer 8

holosystolic mumur at the left lower sternal border

Question 9

The following are radiographic findings in VSD EXCEPT

a. ‘sitting dove’ appearance
b. cardiomegaly
c. ‘boot shaped’ appearance
d. increased pulmonary vascular markings
e. C & D

Answer 9

c. ‘boot shaped’ appearance

This is found in conditions that lead to RV enlargement or hypertrophy.

Question 10

VSDs may be associated with

a. membranous aneurysm
b. aortic cusp prolapse
c. RV infundibular stenosis
d. AOTA
e. NOTA

Answer 10

d. AOTA

Question 11

Device closure via percutaneous catheterization can be done in

a. muscular VSDs
b. VSDs <10 mm
c. supracristal VSDs
d. membranous VSDs
e. NOTA

Answer 11

d. membranous VSDs

Indication:
<8 mm membranous VSD

Question 12

T/F: Anatomic closure of PDA is achieved by 48 hours.

Answer 12

F

Functional closure = 24 hours
Anatomic closure = 2 months (in 90%)

Question 13

A ductus arteriosus is considered patent or persistent if it does not close by

a. 3 months
b. 6 months
c. 9 months
d. 1 year

Answer 13

b. 6 months

Question 14

The following are true of PDA EXCEPT

a. continuous machinery-like murmur at LUSB
b. wide pulse pressure
c. bounding pulse
d. volume overload of RV
e. B & D

Answer 14

d. volume overload of RV

PDA overload the LEFT side since blood is dumped back to the pulmonary circulation and returns to the LA & LV.

Question 15

T/F: ECG of PDA presents with tall R in V6 and deep S in V1.

Answer 15

T

Tall R in V6 and deep S in V1 is characteristic of LVE.

Question 16

Indomethacin is given to medically close PDA. Give another drug that may be used.

Answer 16

ibuprofen (or any other PGE1 inhibitor)

Question 17

True about ASD EXCEPT

a. asymptomatic during early life
b. male preponderance by 4:1
c. volume overload of the right chambers
d. A & B
e. AOTA

Answer 17

d. male preponderance by 4:1

female preponderance by 4:1

Question 18

This type of ASD is associated with abnormal drainage of the right pulmonary vein.

a. primum type
b. secundum type
c. sinus venosus type
d. patent foramen ovale type
e. NOTA

Answer 18

c. sinus venosus type

Question 19

The most common auscultatory finding in ASD.

Answer 19

fixed split S2

A murmur may not be present due to low pressure difference between LA and RA.

Question 20

Complete atrioventricular septal defect is commonly associated with what syndrome?

a. Noonan syndrome
b. Klinefelter syndrome
c. Down syndrome
d. Turner syndrome
e. Castillo syndrome

Answer 20

c. Down syndrome / trisomy 21

Question 21

T/F: Pulmonary stenosis causes pressure overload of the right ventricle.

Answer 21

T

Question 22

Differentiate overload caused by stenosis and regurgitation.

Answer 22

Stenosis causes pressure overload.

Regurgitation causes volume overload.

Question 23

Characterize the murmur of typical pulmonary stenosis.

Answer 23

systolic ejection murmur at LUSB

Question 24

Pulmonary stenosis may present with the following findings.

a. tall R in V1, deep S in V6
b. decreased pulmonary markings
c. normal cardiothoracic ratio
d. A & B only
e. AOTA

Answer 24

e. AOTA

tall R in V1, deep S in V6 = RVH

CT ratio may be normal but have uplifted apex.

Question 25

Give the two surgical treatment options for PS.

Answer 25

percutaneous balloon valvuloplasty

open heart valvotomy

Question 26

Coarctation of the aorta is commonly associated with what syndrome?

a. Noonan syndrome
b. Klinefelter syndrome
c. Down syndrome
d. Turner syndrome
e. Castillo syndrome

Answer 26

d. Turner syndrome / XO

Question 27

This radiographic finding is associated with the development of collaterals due to obstructed aortic flow.

Answer 27

rib notching

Question 28

The following are finding in CoA EXCEPT

a. weak pulses on lower extremities
b. hypotension of upper extremities
c. systolic murmur at L infraclavicular area
d. A & B
e. NOTA

Answer 28

b. hypotension of upper extremities

There is hypertension of UE and hypotension of LE.

Question 29

What is the ‘figure 3’ sign?

Answer 29

The figure 3 is a sign of CoA. It includes:

(1) pre-stenotic dilation of aortic arch and left subclavian artery
(2) indentation at the coarctation site (the tuck or notch)
(3) poststenotic dilatation of the descending aorta

Question 30

Which type of VSD is an infidelity type?

a. membranous VSD
b. perimembranous VSD
c. supracristal VSD
d. muscular VSD
e. NOTA

Answer 30

c. supracristal VSD (because it is doubly committed)

Hahahahaha.