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Phase 3a > Paediatric cardiology medicine > Flashcards

Paediatric cardiology medicine Flashcards

1
Q

What are the 3 main categories of congenital heart disease?

A
  1. Holes - ASD, PDA, VSD, AVSD
  2. Stenosis - coarctation of aorta, AS, PS
  3. Complex / cyanotic (right to left shunt) - transposition of great arteries, tetralogy of fallots
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2
Q

What would be the symptoms of acute cardiac decompensation?

A 
poor feeding
dyspnoea
tachycardia
bradycardia (imminent arrest)
hepatomegaly
cool peripheries
acidosis
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3
Q

What type of CHD is caused by fetal alcohol syndrome?

What CHDs are common in Downs syndrome?

A

Atrial septal defects in fetal alcohol syndrome

ASDs and AVSDs in Downs syndrome

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4
Q

What are the 3 types of atrial septal defect?

A
  1. Ostium secundum = most common, occurs in middle of atrial septum
  2. Ostium primum = occurs low in atrial septum
  3. AVSD
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5
Q

What would be heard on auscultation in a patient with atrial septal defect?

What are the symptoms of an atrial septum defect?

A

Fixed and widely split S2
Ejection systolic murmur in pulmonary area

Palpitations, arrhythmias
Recurrent LRTI + wheeze

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6
Q

ASD - investigations and management

CXR?
ECG?
Management?

A

CXR = Cardiomegaly, globular heart

ECG = RVH, RBBB, superior QRS axis

Management - surgical correction

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7
Q

What is patent ductus arteriosis?

A

Tube connecting aorta and pulmonary artery

Patent = preterm
Persistent = term babies at >1 month
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8
Q

What are the clinical features of a large PDA?

A

Large PDA = CCF + pulmonary HTN

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9
Q

What are the signs on examination of patent ductus arteriosis?

(ECG and CXR often normal)

A

Galloping, collapsing pulse
Heaves and thrills
Continuous machinery murmur in pulmonary area

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10
Q

What is the treatment for PDA?

A
  • Surgery to remove endocarditis risk
  • Ibuprofen / Indomethacin (prostaglandin inhibitor) to close
  • If persistent - surgery at 1 year
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11
Q

Which CHD has the highest risk of endocarditis?

A

VSDs

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12
Q

How do VSDs present

  • Clinically
  • On auscultation
A
  • Usually mild presentation of CHD symptoms
  • Loud pansystolic murmur in lower left sternal edge +/- thrill
  • Loudness inversely proportional to size of VSD
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13
Q

What are the general symptoms of CHD?

A

Failure to thrive / poor feedings
Tachypnoea
Hepatomegaly
Oedema

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14
Q

What are the main investigations for VSD?

A

CXR - cardiomegaly, enlarged PA, pulmonary oedema (HF)
ECG - LVH
Echo - visualise defect

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15
Q

What is the management for VSD?

A

Spontaneous closure if small (20% by 9 months)

Large VSD

  • Diuretics for heart failure
  • Calorie input (NG?)
  • Surgery
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16
Q

What is a complete AVSD?

A

A single 5-leaflet valve between atria and ventricle

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17
Q

What are the features of AVSD?

A
  • present at antenatal USS
  • Cyanosis at birth
  • HF at 2-3 weeks
  • No murmur
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18
Q

What are the investigations and managements for AVSD?

A

ECG normal
Echocardiogram
Screening in Down’s syndrome

Tx = surgical repair by 5 years old to avoid pulmonary HTN

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19
Q

How would a VSD present?

A 
Small - asymptomatic, normal growth
Moderate - poor feeding, FTT, SOB
Large - as above + sweaty and pale
Presents at 6-8 weeks
Persistent pulmonary htn if the newborn may establish at 12 months
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20
Q

What is the pathphysiology of aortic stenosis?

A

Aortic valves are partially fused, restricting bloodflow from the LV.
Often associated with CoA and mitral valve stenosis

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21
Q

What are the clinical features of aortic stenosis?

What is heard on auscultation?

A

Asymptomatic
Critical AS = severe heart failure causing collapse and shock

Ejection systlic murmur in upper right sternal edge, radiating to carotids

22
Q

What would be seen on imaging of aortic stenosis?

What would be seen on ECG?

A

May be normal or have prominent LV

Deep S wave and tall R wave in V2
Downgoing T wave in V6

23
Q

How is aortic stenosis managed in children?

A

Regular echocardiograms
Balloon valvotomy in children with symptoms on exercise
Balloon dilation in older children
Eventually will need valve replacement

24
Q

What are the clinical features of pulmonary stenosis?

A

PV leaflets partially fuse - restricting bloodflow from RV

Usually asymptomatic
Ejection systolic murmur in ULSE, may radiate to back

25
Q

How is Pulmonary stenosis diagnosed and managed?

A

Usually clinical diagnosis
ECG - RV hypertrophy

Mx = transcatheter ballon dilatation

26
Q

What is the basic science of transposition of the great arteries?

A

Aorta connected to RV and PA connected to LV
- O2 blood sent to lungs and deoxygenated blood to body
INCOMPATIBLE WITH LIFE

27
Q

What are the clinical features of transposition of the great arteries?

What would be heard on auscultation?

A

Profound cyanosis (due to mixing)
Presents on day 2 when ductus arteriosus closes
Collapse
Acidosis

Second heart sound loud and single

28
Q

What investigations would be appropriate for a transposition of the great arteries?

A

Check for 22q deletion (DiGeorge syndrome)
CXR - ‘egg on the side’ appearance of heart
ECG normal
Echo - shows abnormality

29
Q

How is transposition of the great arteries treated?

A

Maintain patency of ductus arteriosus with prostaglandin infusion
Balloon atrial septostomy
Surgery in first few days of life

30
Q

What are the 4 pathological features of tetralogy of fallot?

A
  1. Large VSD
  2. Overriding of the aorta
  3. Sub-pulmonary stenosis
  4. Right ventricular hypertrpohy
31
Q

What are the signs and symptoms of tetralogy of fallot?

What genetic mutations is it associated with?

A 
Cyanosis (R-L shunt) which gradually worsens with sudden severe exacerbations - MI/stroke risk
Breathless
Pallor
Irritability
Easily tiring on breast feeding
- trisomy 21
- 22q deletion
32
Q

How is tetralogy of fallot diagnosed?

What would be heard on auscultatino?

A

Cardinal features on echo
CXR = small heart and ‘boot shaped’ apex

Harsh ejection systolic murmur in LLSE

33
Q

How is tetralogy of fallot managed?

A

Close VSD + relieve RV outflow obstru ction

Shunt to increase pulmonary flow

34
Q

What is Ebstein’s anomaly?

What is the cause?

What would be heart on auscultation?

What would be seen on imaging?

A

Posterior leaflets of tricuspid valve are displaces anteriorly

Lithium in pregnancy

Tricuspid regurg (pan-systolic murmur)
Tricuspid stenosis (mid-diastolic murmur)

Enlargement of the right atrium

35
Q

What is Kawasaki’s disease?

Who does it predominantly affect?

What is the major complication of Kawasaki’s?

A

Idiopathic self-limiting systemic vasculitis that most commonly affects children 6 months- 5 years

Asian ethnicity

Coronary artery aneurysm

36
Q

What are the signs and symptoms of Kawasaki’s disease? (MyHEART)

A

Marked FEVER - for 5 days and ≥4 diagnostic criteria:

My - mucosal involvement (strawberry tongue)
H - Hands and feet swell
E - Eyes = bilateral conjunctivitis
A - (lymph)Adenopathy
R - Rash = truncal and polymorphic
T = temperature (>5 days)
37
Q

What are the 3 phases of Kawasaki’s disease?

A
  1. Acute febrile 1-2 weeks (MyHEART)
  2. Subacute 4-6 weeks (remission of fever)
    - Develop coronary artery aneurysms
    - Thrombocytosis, desquamation of digits
  3. Convalescent 6-12 weeks
    - resolution of clinical signs
38
Q

How is Kawasaki’s disease diagnosed?

A 
Clinical
Raised:
ESR
CRP
AST
A1-Antitrypsin
platelets
bilirubin

Echo = shows aneurysms

39
Q

What is the treatment for Kawasaki’s disease?

What is the prognosis for Kawasaki’s?

A
  1. High dose aspirin
  2. IV Immunoglobulin (add pred if no response)
  3. Cardiac follow up

prognosis = good if treated promptly

40
Q

What is Henoch-Schonlein Pupura (HSP)?

A

IgA mediated, autoimmune hypersensitivity vasculitis of childhood.

It affects the skin, joints, gut and kidneys

41
Q

What are the risk factors for HSP?

A

Infections (group A streptococcus, mycoplasma, EBV)
Vaccinations
Environmental (allergens, pesticides,insect bites)

42
Q

What is the clinical presentation of HSP?

A

Classic triad:

  1. Purpura (non-blanching)
  2. Arthritis / arthralgia
  3. Abdominal pain
Other:
- low grade fever
renal involvement
- scrotal oedema
intusseception
- headaches
43
Q

How would you diagnose HSP?

A 
Urinalysis - Hb, Pro
Raised ESR
Raised anti-streptolysin O titres (group A strep)
Raised serum IgA
Raised WCC
44
Q

What is the management for HSP?

What is the prognosis?

What are the possible complications?

A

Usually self limiting
NSAIDS for joint pain
Corticosteroids for arthralgia / may help abdo pain

Most recover in 2 months
GI bleeds, ileus, haemoptysis, AKI

45
Q

What are the signs of infective endocarditis?

What are the causative organisms?

A 
Fever
Heart failure
Anaemia
Rash
Splenomegaly
Haematuria (micro)
Hands - clubbing, splinter haemorrhages
NEW MURMUR

staphs and streps

46
Q

What are the investigations for endocarditis?

A

Positive blood cultures from different sites at different times
Echo

47
Q

What is the management for infective endocarditis?

A

Benzylpenicillin + gentamycin

Advise oral hygeine

48
Q

What is rheumatic fever?

A

Systemic febrile illness caused by a cross-sensitivity reaction to Group A beta-haemolytic streptococcus (eg strep throat)
It is more common in LEDCs

49
Q

What is the diagnostic criteria for rheumatic fever?

A

The Jones criteria

2 major / 1 major + 2 minor plus evidence of preceding strep infection.

50
Q

What are the major criteria for diagnosing Rheumatic fever? (The Jones criteria)

A
  • Carditis (+ve echo / changed murmur / CCF / cardiomegaly
  • Polyarthritis
  • Erythema marginatum
  • Subcutaneous nodules
  • Sydenham’s chorea (neuro)
51
Q

What are the minor criteria for diagnosing Rheumatic fever? (The Jones criteria)

A
  • Fever
  • raised ESR or crp
  • Arthralgia (pain but no swelling)
  • ECG - PR interval <0.2 secs
  • Previous rheumatic fever or HD
52
Q

What is the treatment for rheumatic fever?

A
  • Mainly rest and aspirin
  • Benzylpenicillin then phenoxymethylpenicillin (for throat)
  • prednisolone may halp
  • Can give prophylactic ABx if sore throat in high incidence area / previous rheumatic fever

Phase 3a (13 decks)

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