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Pediatrics > Pediatric Cardiology > Flashcards

Pediatric Cardiology Flashcards

1
Q

[Fetal Circulation]

Trace the flow of oxygenated blood

A
  1. Placenta
  2. IVC
  3. RA
  4. FO
  5. LA
  6. LV
  7. Ascending aorta
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2
Q

[Fetal Circulation]

Trace the flow of deoxygenated blood

A
  1. IVC
  2. RA
  3. Tricuspid Valve
  4. RV
  5. Pulmonary artery
  6. Ductus arteriosis
  7. Descending aorta
  8. Lower part of the body
  9. 2 umbilical arteries
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3
Q

[Fetal Circulation]

Unique features in fetal circulation

A
  1. Ductus venosus
  2. Foramen Ovale
  3. Ductus arteriosus
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4
Q

Fetal cardiac output highly depends on ___

A

HR

SV can be increased

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5
Q

[Fetal Circulation]

What are the effect of interrupting the umbilical cord?

A
  1. Increase SVR

2. Closure of ductus venosus

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6
Q

[Fetal Circulation]

Lung expansion results in____

A
  1. Reduction of the PVR
  2. Functional closure of the FO due to increased pressure in the LA
  3. Closure of PDA as a result of increased arterial O2 saturation
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7
Q

Functional closure of the ductus arteriosus occurs by ____

A

Constriction of the medial, smooth muscle in the ductus within 10-15 hours after birth

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8
Q

The anatomic closure of ductus arteriosus is completed by ____

A

2-3 weeks

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9
Q

[Fetal Circulation]

Effect of removing the placenta in SVR

A

SVR increases

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10
Q

[Fetal Circulation]

the closure of PDA is dependent of

A

Low O2 and High prostaglandins

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11
Q

What is the strongest stimulus for contraction of the ductal smooth muscles in the ductus arteriosus?

A

Post natal increase in O2 saturation

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12
Q

[Murmur]

Systolic ejection or blowing murmur are best heard on the ___

A

base or at the 2nd ICS through stenotic strucutres

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13
Q

[Murmur]

Systolic regurgitant murmur is best heard in ____

A

apex or at the left lower sternal border

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14
Q

PDA persisting beyond ____ life in a term infant rarely closes spontaneously or with pharmacologic intervention

A

1st week of life

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15
Q

[Congenital Heart Disease]

What are your Acyanotic Heart Disease

A
  1. VSD
  2. ASD
  3. PDA
  4. COA
  5. ECD
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16
Q

[Congenital Heart Disease]

What are examples of cyanotic heart disease with decreased pulmonary blood flow?

A
  1. Pulmonary atresia
  2. Pulmonary stenosis
  3. TOF
  4. Tricuspid atresia
  5. Ebstein anomaly
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17
Q

[Congenital Heart Disease]

What are examples of cyanotic heart disease with increased pulmonary blood flow?

A
  1. TOGA
  2. TAPVR
  3. TA
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18
Q

What is the most common type of ASD?

A

Ostium seccundum

which is present at the site of fossa ovalis

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19
Q

[Congenital Heart Disease]

Acyanotic
Systolic ejection murmur
2nd LICS
Widely split S2

Right sided enlargement

A

ASD

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20
Q

[Congenital Heart Disease]

Acyanotic
Systolic regurgitant murmur at LLSB
Loud and single S2

Left sided enlargement; biventricular hypertrophy if Eisenmenger Syndrome

A

VSD

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21
Q

[Congenital Heart Disease]

Acyanotic

Continuous “machinery-like” at 2nd left infraclavicular area

Bounding pulses
Wide pulse pressure
Left-sided enlargement
Enlarged aorta

A

PDA

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22
Q

Most common cyanotic heart disease

A

TGA

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23
Q

What are the various mechanisms of hypoxic spell?

A
  1. Increase SVR
  2. RVOT obstruction
  3. Decrease pulmonary blood flow, pO2, pH, pCO2
  4. Increase SVR
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24
Q

[Management of Hypoxic Spell]

How will you manage RVOT obstruction?

A

Propranolol

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25
Q

[Management of Hypoxic Spell]

How will you address systemic venous return?

A

Knee Chest Position

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26
Q

[Management of Hypoxia Spell]

How will you address Increased systemic vascular resistance?

A

Vasoconstrictor

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27
Q

[Management of Hypoxic Spell]

How will you address hyperpnea or hyperventilation?

A

Morphine

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28
Q

[Management of Hypoxic Spell]

How will you address the decreased pBF, pO2, acidic pH

A

O2, NaHCO3

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29
Q

What is the dose of morphine sulfate to suppress the respiratory center?

A

0.2mg/kg/dose SC

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30
Q

[Treatment for TOF]

Used to vasoconstrict and increase SVR

A
  1. Phenyephrine 0.02 mg/kg IV

Ketamine 1-3mg/kgIV over 60s increases SVR

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31
Q

[Treatment for TOF]

stabilize vascular reactivity of the arteries preventing a sudden decrease in SVR

A

Propranolol 0.01-0.25 mg/kg

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32
Q

Surgical technique to augment pulmonary blood flow

A

Blalock-Taussig Shunt

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33
Q

(Not 2DE), method to distinguish CHD from pulmonary disease

A

Hyperoxia tes

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34
Q

How will you perform hyperoxia test?

A

100% FiO2 for 10-15 minutes

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35
Q

heart diseases associated with this syndrome

Down

A

Endocardial Cushion Defect

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36
Q

heart diseases associated with this syndrome

Marfan

A

MVP, Progressive enlargement of the aorta

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37
Q

heart diseases associated with this syndrome

Hunter Syndrome

A

thickening of cardiac valves

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38
Q

heart diseases associated with this syndrome

Noonan

A

Pulmonary stenosis

  1. Facial anomalies
  2. Short stature
  3. Webbed neck
  4. Chest deformities
  5. Undescended testes
  6. Pulmonary stenosis
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39
Q

[Diagnosis]

Cyanosis manifesting within few hours at birth or within few days of life

A

TGA

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40
Q

[Diagnosis]

Cyanosis manifesting after the first year of life, usually in an infant or a toddler

A

TOF

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41
Q

What are the heart defects that permit mixing of the 2 circulations for survival

A
  1. ASD
  2. VSD
  3. PDA
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42
Q

What is the most common cause of cyanotic CH in newbornd

A

TGA

Unresponsive to oxygen inhalation

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43
Q

What is the pathognomonic CXR finding of TGA

A

Egg-shaped cardiac sillouette with a narrow superior mediastinum

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44
Q

What are the components of tricuspid atresia?

A
  1. Atretic TV
  2. Hypoplastic RV
  3. VSD
  4. ASD
  5. Pulmonary stenosis
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45
Q

What are the components of truncus arteriosos?

A
  1. Pulmonary arteries arise from aorta
  2. Truncal valve overrides the VSD
  3. VSD, large
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46
Q

Most commonly associated congenital heart defect in Turner Syndrome/

A

CoA

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47
Q

How does CoA appear on X-ray?

A
  1. Rib notching in children around 7 years old
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48
Q

Treatment of choice for neonates with severe CoA

A

PGE1 to reopen ductus

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49
Q

[Diagnosis]

Weak or absent femoral pulses
BP arms > legs
Rib notching

A

CoA

Tx: Primary anastomosis or patch aortoplasty

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50
Q

[Diagnosis]

Systolic ejection murmur at LUSB with radiation to the upper back

A

Pulmonic stenosis

Brock Procedure (balloon valvuloplasty)

51
Q

[Diagnosis]

Systolic ejection murmur at RUSB

A

Aortic stenosis

52
Q

[Diagnosis: CXR Findings]

boot-shaped heart / Coeur en sabot

A

TOF

53
Q

[Diagnosis: CXR Findings]

Egg on string

A

TGA

54
Q

[Diagnosis: CXR Findings]

Snowman

A

TAPVR

55
Q

[Diagnosis: CXR Findings]

Figure of 8

A

TAPVR

56
Q

[Diagnosis: CXR Findings]

Rib notching

A

CoA

57
Q

[Diagnosis: CXR Findings]

Inverted E

A

CoA

58
Q

[Diagnosis: CXR Findings]

3 sign

A

CoA

59
Q

[Diagnosis]

Child, exercise intolerance, easy fatigability

late systolic murmur with an opening click

A

MVP

60
Q

[Diagnosis]

Child, exercise intolerance, easy fatigability

Disparity in pulsation and BP in the arms and legs

Weak popliteal, posterior tibial, and dorsalis pedis

A

CoA

61
Q

[Diagnosis]

Child, exercise intolerance, easy fatigability

S2 widely split and fixed

A

ASD

62
Q

[Diagnosis]

Child, exercise intolerance, easy fatigability

loud, harsh, blowing systolic murmur

A

VSD

63
Q

[Diagnosis]

Child, exercise intolerance, easy fatigability

Wide pulse pressure, bounding peripheral arterial pulses, continuous murmur

A

PDA

64
Q

[Diagnosis: Indication of Surgical Procedure]

Blalock-Taussig Shunt with GoreTex Conduit

A

TOF

65
Q

[Diagnosis: Indication of Surgical Procedure]

Rashkind artrial septostomy

A

TGA

66
Q

[Diagnosis: Indication of Surgical Procedure]

Jantene arterial switch

A

TGA

67
Q

[Diagnosis: Indication of Surgical Procedure]

Senning ang mustart

A

TGA

68
Q

[Diagnosis: Indication of Surgical Procedure]

Fontan Procedure

A

TA

69
Q

[Diagnosis: Indication of Surgical Procedure]

Norwood procedure

A

Hypoplastic Left Heart Syndrome

70
Q

[Diagnosis: Indication of Surgical Procedure]

Glenn anatomosis

A

Hypoplastic left Heart syndrome

71
Q

[Diagnosis]

RV pumping blood to the the lungs and out of the body via patent PDA

A

Hypoplastic Left Heart Syndrome

72
Q

[Associated Heart Disease]

Rubella

A

PDA

73
Q

[Associated Heart Disease]

DM

A

TGA

74
Q

[Associated Heart Disease]

Lupus

A

Complete heart block

75
Q

[Associated Heart Disease]

Aspirin

A

persistent pulmonary hypertension

76
Q

[Associated Heart Disease]

lcohol

A
  1. VSD

2. PS

77
Q

[Associated Heart Disease]

Lithium

A

Ebstein anomaly

Tricuspid valve is displaced toward the apex

78
Q

What are the major components of the Jones Criteria?

A
  1. Joints/Polyarthritis
  2. Carditis
  3. Nodules, subcutaneous
  4. Erythema marginatum
  5. Syndeham chorea
79
Q

What are the minor components of the Jones Criteria

A
  1. Fever
  2. RHD/RH previously
  3. Arthralgia
  4. Prolonged PR interval on ECG
  5. Elevated acute phase reactants: EST/CRP/Leukocytosis
80
Q

What is the most consistent feature of ARF?

A

Valvulitis

81
Q

In RF, erythema marginatum spares what part of the body?

A

Face

Nonpruritic serpiginous or annular erythematois evanescent rash prominent on the trunk and inner proximal portions of the extremities

82
Q

[RF]

___ spontaneous purposeless movements followed by motor weakness

A

syndeham chorea

83
Q

What is the set point fever for high risk patients with RF?

A

> 38 deg C

Low rislk, >38.5 deg C

84
Q

ASO titers become elevated ___ weeks after strep infection

A

2 weeks

Peaks at 4-6 weeks

85
Q

What are the criteria to demonstrate evidence of preceding strep infection?

A
  1. Increased or rising ASO or anti-DNAse B
  2. Positive throat culture for GABHS
  3. Positive rapid group A strep carbohydrate antige
86
Q

What is the criteria to diagnose initial ARF?

A
  1. > 2 major manifestations

2. 1 Major plus 2 minor manifestations

87
Q

What is the criteria to diagnose recurrent RF?

A

Reliable history of ARF or established RHD

  1. 2 major
  2. 1 major + 2 minor
  3. 3 minor
88
Q

What is the DOC for for acute RF?

A
  1. Oral Penicillin or Erythromycin x 10 dyas

2. Single IM injection of benzathin penicillin

89
Q

What are the drugs used to eradicate Streptococcus?

A
  1. Penicillin VK 200-500mg QID x 10 days
  2. Benzathine PCN 0.6-1.2 MU IM
  3. Erythromycin 250mg TID x 10 days
90
Q

What is the secondary prophylaxos for RF?

A
  1. Pen VK 250mg BID PO

2. Benzathin PCN 0.6-1.2 MU IM q 21 days

91
Q

[Duration of prophylaxis for ARF]

RF without carditis

A

5 year or until 21 years of age

92
Q

[Duration of prophylaxis for ARF]

RF with carditis but no residual heart disease

A

10 years or until 21 years old

93
Q

[Duration of prophylaxis for ARF]

RF with carditis and residual HD

A

10 years or until 40 years of age

94
Q

What are the causative agents in Infective Endocarditis?

A
  1. Viridans streptococci

2. S. aureus

95
Q

What is the echocardiographic finding in IE?

A
  1. Oscillating mass vegetations
    2 Regurgitant flow near a prostheisis
  2. abscess
  3. partial dehiscence of proshetic valve, new valve regurgitant
96
Q

How will you collect samples for blood culture if you suspect IE?

A
  1. 2 separate sites 12 hours apart

2. 3 or more 1 hour apart

97
Q

What are the minor criteria in IE?

A
  1. Fever
  2. Predisposing condition
  3. Vascular
  4. Immunologic
  5. Microbiological evidence
  6. Echocardiographical
98
Q

[PE in IE]

linear lesions beneath the nails

A

Splinter hemorrhages

99
Q

[PE in IE]

painless small erythematous hemorrhagic lesions on the palms and soles

A

Janeway lesions

100
Q

[PE in IE]

Tender, pea-sized intradermal nodules in the pads of fingers and toes

A

Osler nodes

101
Q

What antibiotics will you give after a dental procedure with manipulation of the gingiva

Patient allergic to amoxicillin

A

Clindamycin 600mg orally 30-60 minutes before the procedure

102
Q

[Murmurs]

Characteristics of innocent murmur

A
  1. Soft
  2. Systolic
  3. Short
  4. Musical/vibratory
  5. Symptomless
  6. Normal diagnostics
103
Q

[Murmurs: Innocent or pathologic]

Grade I to grade II
sternal border
soft systolic

A

Innocent

104
Q

[Murmurs]

Characteristics of pathologic murmur

A
  1. Diastolic
  2. Pancystolic
  3. Late systolic
  4. Continuous
  5. Thrill
105
Q

[Murmurs: Grades]

Loud but no thrill

A

Grade III

106
Q

[Murmurs: Grades]

Loud, with thrill

A

Grade IV

107
Q

[Murmurs: Grades]

Thrill and audible with edge of the stethoscope

A

Grage V

108
Q

[Murmurs: Grades]

Thrill and audible with stethoscope just off the chest

A

Grade VI

109
Q

[Infective endocarditis: organism]

Normal person
No underlying disease

A

Staphylococcus

110
Q

[Infective endocarditis: organism]

Underlying heart disease
Dental procedure

A

viridans Streptococcus

111
Q

[Infective endocarditis: organism]

Gut or lower bowel manipulation

A

Group D streptococcus

112
Q

[Infective endocarditis: organism]

after an open heart procedure

A

fungal

113
Q

[Infective endocarditis: organism]

IV drug abusers

A
  1. Staphylococcus and

2. Pseudomonas

114
Q

[Infective endocarditis: organism]

+ CVP
+ Prosthetic valves

A

Coagulase negative staph

115
Q

[Diagnosis]

Child with fever, arthralgia, myalgia, acutely ill looking

new heart murmur

Organism?

A

staphylococcus aureus

116
Q

[Diagnosis]

Child, known CHD,
fever, fatigue, weight loss, painful skin lesions on the finger

poor oral hygiene

A

viridans streptococcus

117
Q

[Diagnosis]

Child, known CHD,
fever, fatigue, weight loss, painful skin lesions on the finger

underwent root canal treatment

A

viridans streptococcus

118
Q

[Diagnosis]

Child, known CHD,
fever, fatigue, weight loss, painful skin lesions on the finger

recent repair of VSD

A

fungal

119
Q

[Diagnosis]

Child, known CHD,
fever, fatigue, weight loss, painful skin lesions on the finger

IV drug user

A

pseudomonas

120
Q

Fishmouth buttonhole deformity

A

Mitral valve stenosis

121
Q

What are the consequences of Mitral Stenosis?

A

LA MV LV

  1. LA enlargement
  2. Increased LA pressure
  3. Pulmonary congestion
  4. Pulmonary HPN
  5. AF
122
Q

How to differentiate VSD and MR since both have systolic regurgitant type of murmur

A
  1. VSD - no transcmission to LAAL

2. MR - with transmission to LAAL

123
Q

[Diagnose]

High pitched diastolic murmur loudest at 3rd to 4th LICS, more audible when sitting and leaning forward

A

Aortic Regurgitation

  1. Diastolic thrill at 3rd LICS
  2. Hyperdynamic precordium
  3. Bounding water hammer puls
  4. Wide pulse pressure

Pediatrics (15 decks)

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