Paediatrics

Question 1

Give examples of acyanotic congenital heart defects.

Answer 1

Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta

Question 2

Give examples of cyanotic congenital heart defects.

Answer 2

Tetralogy of Fallot
Total anomalous pulmonary venous return
Tricuspid atresia
Transposition of great vessels
Truncus arteriosus
Hypoplastic right heart

Question 3

What are the features of tetralogy of Fallot?

Answer 3

Over-riding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy
Ventricular septal defect

Question 4

What are ‘duct-dependent’ heart defects?

Answer 4

These heart defects depend on PDA (blood flow through the ductus arteriosus) for adequate oxygenated blood circulation

Question 5

Give examples of duct-dependent heart defects.`

Answer 5

Transposition of the great vessels
Tetralogy of Fallot
Hypoplastic left heart

Question 6

What is tricuspid atresia?

Answer 6

The absence or closure of the tricuspid valve

Question 7

What medication is used to maintain a duct?

Answer 7

Alprostadil (prostaglandin)

Question 8

What medication is used to close a duct?

Answer 8

Indometacin (NSAID)

Question 9

What structure in the foetal heart allows blood to flow from the right atrium to the left atrium?

Answer 9

Foramen ovale

Question 10

Describe the findings on auscultation of a ventricular septal defect

Answer 10

Pansystolic murmur loudest at the lower left sternal edge

Question 11

Describe the findings on auscultation of an atrial septal defect

Answer 11

Widely split second heart sound loudest at the upper left sternal edge

Question 12

Define patent foramen ovale (PFO)

Answer 12

Persistence of the foramen ovale beyond one-year-old

Question 13

What is a complication of patent foramen ovale?

Answer 13

Paradoxial embolism - thrombus passess through right-to-left shunt and enters systemic circulation where it causes end-organ failure (stroke)

Question 14

Describe the findings on auscultation of a patent ductus arteriosus

Answer 14

Loud continuous murmur (machinery murmur)

Question 15

What is coarctation of the aorta?

Answer 15

A narrowing of the aorta as a result of closure of the ductus arteriosus

Question 16

Describe the key findings on examination of coarctation of the aorta

Answer 16

Weak femoral pulses

Different pre- and post-ductal saturations

Question 17

Which limbs should pre- and post-ductal saturations be taken from?

Answer 17

Pre-ductal saturations - right arm/hand.

Post-ductal saturations - any foot.

Question 18

Describe the general findings on examination of cyanotic heart defects

Answer 18

Blue babies (cyanosis)
Nail clubbing
Failure to thrive (poor weight gain)
Exertional dyspnoea, tachypnoea, fatigue

Question 19

What characteristic action will individuals with a cyanotic heart defect perform for relief?

Answer 19

Squatting