Mehl. Cardio: tetrology, fetal HTN, coarctation

Question 1

M. Adams Stokes attack. definition?

Answer 1

Idiopathic arrhythmia disorder that causes transient hypoxia to the brainstem, resulting in seizure-like episodes.

Question 2

M. Adams Stokes attack. causes what -> CP?

Answer 2

causes transient hypoxia to the brainstem, resulting in seizure-like episodes.

EEG does not show any seizure activity.

Question 3

M. Adams Stokes attack. What shows EEG?

Answer 3

EEG does not show any seizure activity

Question 4

M. Congenital heart block. In what maternal pathology?

Answer 4

SLE in pregnant women can cause congenital heart block in neonates. Sounds weird, but shows up on NBME somewhere.

Question 5

M. Persistent fetal hypertension. Aka?

Answer 5

persistent fetal circulation.

Question 6

M. Persistent fetal hypertension. - Q will give a post-term birth at 42 or 43 weeks + meconium-stained fluid + echo of the neonate shows a RàL shunt across the foramen ovale.

Answer 6

Student says, “Wait, but isn’t the foramen ovale between the atria, and that’s only open in the fetus but is supposed to close after birth?” Correct. Hence we have persistent fetal circulation.

Question 7

M. Persistent fetal hypertension. failure of what (answer on usmle)?

Answer 7

Answer on USMLE will be “failure of pulmonary vasodilation.”

Question 8

M. Persistent fetal hypertension.
Meconium aspiration syndrome can decr. opening of the lung vasculature, leading to incr. right heart pressure and ­ risk of persistent fetal circulation.

Answer 8

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Question 9

M. Tetralogy of Fallot. 4 CP?

Answer 9

1) Pulmonic stenosis; 2) RVH; 3) overriding aorta; 4) VSD.

Question 10

M. Tetralogy of Fallot. Which component determines prognosis?

Answer 10

answer is the degree of pulmonic stenosis

Question 11

M. Tetralogy of Fallot. The child will not be cyanotic at birth, but then years later, will develop…….??? syndrome

Answer 11

Eisenmenger syndrome (i.e., a reversal of the L -> R shunt over the VSD to be R -> L) and cyanosis, where the stem gives a school-age kid who squats on the playground to relieve symptoms.

Question 12

M. Tetralogy of Fallot. Squating does what on afterload?

Answer 12

Squatting ­ incr. afterload, which incr. ­ LV pressure, which ̄decr. the pressure gradient of the R -> L shunt, thereby mitigating cyanosis.

Question 13

M. Tetralogy of Fallot. Squating does what on the preload?

Answer 13

Squatting also incr.­ preload by incr.­ venous return back to the right heart. But it is the effect of ­ incr. afterload that is most related to the decr. in symptoms.

Question 14

M. Coarctation. definition?

Answer 14

Refers to narrowing of the aortic arch (this is referred to as coarctation; do not use the word stenosis to describe this).

Question 15

M. Coarctation. classically seen in what syndrome?

Answer 15

Classically seen in Turner syndrome, but absolutely not mandatory. Shows up idiopathically in plenty of NBME Qs. I point this out because students often think the patient must have Turner syndrome.

Question 16

M. Coarctation. CP?

Answer 16

Presents as upper extremities that have higher BP, brisk pulses, and are warmer; the lower extremities have lower BP, weak pulses, and are cooler.

Question 17

M. Coarctation.
Sometimes the Q can just say, “the radial pulses are brisk.” -> The implication is, “Well if they’re saying specifically that the radial pulses are brisk, that must mean the pulses in the legs aren’t.”

Answer 17

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Question 18

M. Coarctation. Murmur sound not important for USMLE. Can sometimes be described as a systolic murmur heart in the infrascapular region.

Answer 18

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Question 19

M. Coarctation. what heart failure?

Answer 19

Can cause LVH with left-axis deviation ECG (on NBME).

Question 20

M. Coarctation.
USMLE doesn’t give a fuck about pre- vs post-ductal. Pre-ductal in theory will be a very sick neonate. Post-ductal will be an adult (most cases).

Answer 20

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