Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 5 - Paediatrics > Paeds CARDIO > Flashcards

Paeds CARDIO Flashcards

1
Q

Recall 2 differentials for a right atrium anomaly in children

A

Tricuspid atresia: requires ASD + VSD to remain patent to allow shunt
Ebstein’s anomaly: less severe as not reliant on shunting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Recall 3 differentials for a right ventricle anomaly in children

A

Pulmonary stenosis
Pulmonary atresia
Tetralogy of Fallot

(This is what it says in Ludley’s notes - bit confused about how pulmonary valve abnormalities are ventricular issues rather than atrial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the tetralogy of fallot?

A

A cyanotic heart defect that is characterised by four features:
VSD
Overarching aorta
Right outflow tract obstruction
RV hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Recall 2 differentials for a left atrium anomaly in children

A

Mitral stenosis
Mitral atresia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Recall 4 differentials for a left ventricle anomaly in children

A

Hypoplastic left heart
Coarctation of aorta
Interrupted arch
Aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is ToGA?

A

Transposition of the Great Arteries - a congenital heart defect in which the aorta leaves the right ventricle and the pulmonary trunk leaves the left ventricle, resulting in the complete separation of the systemic and pulmonary circulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When does ToGA present?

A

When ductus arteriosus closes at 2-4 days old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can ToGA be managed?

A

Give prostaglandin infusion to keep DA open
Need urgent surgical readjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How quickly after birth does AVSD present?

A

First few hours of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where is the ductus arteriosus?

A

Between the aorta and pulmonary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When do aortic problems (coarctation or stenosis) present?

A

First few weeks of life (but not within days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What test is used to diagnose heart disease in a cyanosed neonate, and how is it done?

A

Nitrogen washout test
Give 100% oxygen for 10 mins
Measure right radial artery blood gas oxygen
If it stays low (<15kPa) = positive for CHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a ‘blue baby’ presentation a red flag for?

A

R-L shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a ‘breathless baby’ presentation indicative of?

A

L-R shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recall the 3 types of L-R shunt

A

VSD, ASD, PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the differentials for cardiac outflow obstruction and how can you clinically differentiate between them

A

If child is otherwise well: P or A stenosis
If child is also in CV collapse + shock: coarctation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does ‘cyanotic heart disease’ refer to?

A

Right to left shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the types of ASD and which is more common?

A

Secundum (more common): defect in atrial septum (failure of closure of foramen ovale)
Partial (AVSD): defect of AV septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs and symptoms of ASD?

A

Asymptomatic
May have recurrent chest infections/ wheeze

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What murmur is associated with ASD?

A

Ejection systolic murmum at ULSE
Fixed wide splitting of S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How will the different types of ASD appear on ECG?

A

Secundum: RBBB + RAD
Partial: superior QRS axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How should the different types of ASD be managed?

A

Secundum: cardiac catheterisation + insertion of occlusive device
Partial: surgical correction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What investigation is diagnostic of ASD?

A

Echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How are VSDs classified?

A

By size:
small <3mm
large >3mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the signs and symptoms of VSD?
Small: May be asymptomatic, may have breathless 3m old with normal sats, poor feeding with tiredness, LOUD murmur Large: Heart failure, SOB, recurrent chest infections, hepatomgaly
26
Describe the murmur in VSD?
Small: LOUD, Pan-systolic, LLSE Large: SOFT pan-systolic murmur
27
How shouls small VSDs be managed?
Self-limiting: they close over time
28
What does a small VSD increase the risk of?
Endocarditis
29
What does large VSD increase the risk of?
Eisenmenger syndrome - "the process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect causes pulmonary HTN + eventual reversal of the shunt into a cyanotic right-to-left shunt"
30
How should a large VSD be managed?
CDC Calories (additional calorie input) Diuretics Captopril Surgery is usually performed at 3-6 months to prevent permanent lung damage from pulmonary HTN + high blood flow
31
By what time should the DA usually close?
1 month postpartum
32
Describe the murmur in PDA
Continuous 'machine-like' at ULSE
33
What would be found OE in PDA?
Left sub-clavicular thrill Heaving apex beat Wide pulse pressure Bounding, collapsing pulses Resp symptoms from increased work
34
Recall the medical and surgical management of PDA
Medical: Indomethacin (NSAID): to prompt duct closure Surgical: at 1 year
35
How can cyanosis be tested for?
Hyperoxia nitrogen washout test
36
How should cyanosis be immediately managed?
ABCs Prostaglandin infusion (to maintain PDA patency)
37
Recall the timeline of presentation of the different types of cyanotic heart disease after birth
<10 mins: Tricuspid atresia Few hours: ToGA Up to 3 weeks: AVSD Any age (at a few days, often): ToF 10-15 years: Eisenmenger
38
Which 2 types of cyanotic HD produce an ESM at the left sternal edge?
ToGA + ToF
39
What is Ebstein's abnormality?
Malformation of tricuspid valve leading to severe tricuspid regurgitation
40
What maternal medication is associated with Ebstein's abnormality?
Lithium
41
What would be heard on auscultation in Ebstein's abnormality?
split 1st + 2nd heart sounds
42
How should Ebstein's be managed?
Prostaglandin - cone repair of tricuspid valve
43
What is tricuspid atresia?
Complete absence of tricuspid valve: so LV is the only effective ventricle (right too small)
44
Describe the presentation of tricuspid atresia
Cyanosis + SOB within first 10 mins of life
45
What is the murmur in tricuspid atresia?
ESM at LSE due to VSD
46
Recall in detail the management of tricuspid atresia
1st need to maintain a secure supply of blood to the lungs Option 1 is a Blalock-Taussig shunt insertion Option 2 is pulmonary banding operation to reduce pulmonary blood flow COMPLETE CORRECTIVE SURGERY NOT POSSIBLE IN MOST CASES
47
Why is ToGA not instantly fatal?
Usually found alongside ASDs/ VSDs/PDAs etc which aid mixing
48
What is heard upon auscultation in ToGA?
Loud S2 but no murmur
49
What investigations should be done in suspected ToGA?
CXR - cardiomegaly, 'egg-on-a-string' appearance Echo - diagnostic
50
What would a CXR show in ToGA??
Narrow upper mediastinum ('egg on side')
51
Recall the management of ToGA
Immediate prostaglandin infusion to maintain PDA patency Balloon atrial septostomy (this tears atrial septum down to allow mixing) Arterial surgery to switch the vessels
52
What is the most common association with AVSD?
Down's syndrome
53
How does AVSD present?
Cyanosis at 2-3w of life
54
How should AVSD be managed?
Treat heart failure medically + surgery at 3 months
55
What are the 4 characteristics of the tetralogy of fallot?
VSD Overriding aorta (compression of PA --> ) Pulmonary stenosis (back pressure --> ) RVH
56
What would be heard on auscultation in tetralogy of fallot?
Murmur from pulmonary stenosis = loud ESM at left lower sternal border
57
What investigations should be done in suspected tetralogy of fallot?
CXR Echo
58
What does CXR show in tetralogy of fallot?
Boot-shaped, small heart due to RVH
59
How is tetralogy of fallot managed?
1st medical, then surgery at 6 months old Medical: PG/ alprostadil to maintain PDA + reverse severe cyanosis Severe/ prolonged cyanosis should be managed using a BT shunt from subclavian-pulmonary artery or balloon dilatation of RV outflow
60
What is Eisenmenger syndrome?
Irreversibly raised pulmonary vascular resistance from chronically raised pulmonary arterial pressure + flow (ie from a large VSD or chronic PDA) which leads to formation of a right to left shunt
61
Recall the pathophysiology of Eisenmenger syndrome
High pulmonary flow from large L-to-R shunt untreated Artery wall thickens Resistance increases Eventually shunt decreases + child becomes less symptomatic At 10-15y the shunt reverses as a teenager + they become blue + cyanotic
62
How should Eisenmenger be managed?
Early intervention for pulmonary blood flow Heart transplantation not easy but can be done
63
What is the cause of congenital aortic/ pulmonary stenosis?
Partial fusion of valve leaflets
64
What are the most likely co-existent conditions with aortic/pulmonary stenosis?
Coarctation of aorta + mitral valve stenosis
65
What are the signs and symptoms of aortic/pulmonary stenosis?
NO CYANOSIS AS: carotid thrill (ESM) PS: no carotid thrill, harsh heart murmur at LSE (ESM)
66
How should a/p stenosis be managed?
Transcatheter balloon dilatation
67
When does coarctation of the aorta present?
3 days - a few weeks of life
68
Recall some signs and symptoms of coarctation of the aorta
Sx: asymptomatic Signs: 1. ESM 2. High BP in arms, low BP in legs
69
How should coarctation be managed?
If sick infant: follow ABC + PG infusion guidelines If well child --> surgical repair OR balloon angioplasty + stenting
70
Recall the signs and symptoms of hypoplastic left heart syndrome
Often the sickest of all the left-outflow presentations Will be cyanotic
71
How should hypoplastic left heart syndrome be managed?
1st = ABCs + PG 2nd = Blalock-Taussig (BK) shunt or Norwood Stage 1 3rd = BK shunt removal --> Glenn/ hemi-Fontan --> Fontan/ Total Cavo-Pulmonary Connection
72
What is a BK shunt?
Arterficial ductus arteriosus
73
What HR is expected in SVT?
250-300bpm
74
Recall the main symptom of SVT in neonates
Hydrops fetalis
75
What would be seen on an ECG in SVT?
Narrow complex tachycardia + T wave inversion due to ischaemia
76
How should SVT be managed?
1. Circulatory + respiratory support (correct any tissue acidosis) 2. Vagal stimulating manoevres - 80% success 3. IV adenosine 4. Electrical cardioversion with synchronised DC shock if adenosine fails
77
What is the common cause of rheumatic fever?
Group A beta-haemolytic strep
78
What age child can get rheumatic fever?
5-15 y/o
79
What is the long term risk of rheumatic fever?
Mitral stenosis
80
Describe the typical presentation of rheumatic fever
Latent interval of 2-6w after pharyngeal infection: polyarthritis Pericarditis Erythema marginatum (map-like outlines)
81
What are the diagnostic criteria for rheumatic fever?
Jones criteria 2 majors / 1 major + 2 minors Major = CASES Carditis, Arthritis, SC nodules, Erythema marginatum, Sydenham's chorea Minor = FRAPP: fever, raised ESR/CRP, Arthralgia, Prolonged PR, Previous RF
82
How should rheumatic fever be managed?
Anti-inflammatories High dose aspirin (suppresses inflammatory responses in heart + joints) Abx (if evidence of present infection) Corticosteroids (if not resolved rapidly)
83
What should be done following resolution of rheumatic fever?
Prophylatic monthly injections of benzyl penicillin until age 21 May need surgical valve repair
84
Recall the signs and symptoms of infective endocarditis in a child
Necrotic skin lesions: from infected emboli Splinter haemorrhages Changing cardiac signs Fever, aneamia, pallor Splenomegaly Arthritis/ arthralgia Clubbing
85
How is infective endocarditis diagnosed in children?
Multiple blood cultures (before ABx) + echocardiography to identify vegetations
86
What is the most common pathogen implicated in paediatric IE?
Streptococcus viridians
87
How should infective endocarditis be managed in children?
6 weeks IV Abx Strep viridians (native/prosthetic valve) = amoxicillin + gentamicin/vancomycin Staph aureus (native valve): Amoxicillin/ vancomycin/ daptomycin Staph aureus (prosthetic valve): nafcillin/ oxacillin
88
How is the liver affected by cardiac failure?
May see hepatomegaly
89
How is the respiratory system affected by cardiac failure?
Increased RR Recurrent chest infections
90
What basic investigations are necessary in cardiac failure?
O2 sats BP FBC U+Es calcium BNP/ANP
91
Recall systematically the management of paediatric cardiac failure
Decrease preload: diuretics (furosemide)/ GTN Enhance contractility: eg digoxin, dopamine, dobutamine Reduce afterload: ACE inhibitors Improve oxygen delivery: B-blockers (eg carvedilol)
92
How should cyanosis be managed?
Prostaglandin infusion
93
How would tetralogy of fallot present?
Cyanosis – possibly at rest depending on severity Dyspnoea on feeding / crying / exertion Failure to thrive Murmur – usually harsh, and at the left sternal edge, grade 3-6. - Due to pulmonary outflow obstruction rather than VSD - Systolic thrill may also be present
94
What is the most common congenital heart defect?
Tetralogy of Fallot
95
What is a 'tet spell'?
- Sudden onset dyspnoea / cyanosis - Typically triggered by an event that slightly reduces O2 concentration (e.g. crying, defecating, feeding, distress) - Can be a vicious cycle, as the tet spell can make the child more distressed - Sometimes preceded by rapid, deep breathing - This increases venous return to the right ventricle, whose output is mainly via the aorta – and thus this is part of the vicious cycle Severe spells can lead to death.
96
Who do tet spells tend to affect?
Babies aged between 2 and 4 months old
97
How may a toddler react to a tet spell?
Some toddlers may adopt a squatting position – which reduces venous return to the heart, and may help increase blood O2
98
What are some risk factors for ToGA?
Maternal diabetes Maternal smoking Advanced maternal age
99
Why is ToGA a 'shunt-dependent' defect?
Because infants survive only if a shunt between the two circulations exist to mix oxygenated blood into the systemic circulation such as: - Patent ductus arteriosus (PDA) - Ventricular septal defect (VSD) - Atrial septal defect (ASD) - Patent foramen ovale (PFO)
100
What the normal HR ranges for a) under 1, b) 1-2, c) 2-5, d) 5-12 and e) >12?
<1: 110-160 1-2: 100-150 2-5: 95-140 5-12: 80-120 >12: 60-100 (normal adult range)
101
What the normal RR ranges for a) under 1, b) 1-2, c) 2-5, d) 5-12 and e) >12?
<1: 30-40 1-2: 25-35 2-5: 25-30 5-12: 20-25 >12: 15-20

Year 5 - Paediatrics (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions