Pediatrics - Cardiology (30) Flashcards
PED - 6.1
Which congenital heart defect causes severe cyanosis in the first days of life?
A) aortico-pulmonary fenestration
B) postductal coarctation of the aorta
C) atrioventricular septal defect
D) transposition of the great arteries
E) persistent ductus arteriosus
ANSWER
D) transposition of the great arteries
EXPLANATION
In transposition of the great arteries there are two separate circulations, the aorta arises from the right ventricle and receives deoxygenated blood from the body. Mixing is only possible via the fetal connections. Urgent balloon atrioseptostomy may be indicated. In A, B, C and E the shunt is from left to right, thus no cyanosis would occur.
PED - 6.2
A cyanotic newborn has a chest x-ray, which shows decreased vascularisation of the lungs. Which of these congenital heart defects is the most likely diagnosis?
A) Transposition of the great arteries
B) Total anomalous pulmonary venous return
C) Pulmonary atresia
ANSWER
C) Pulmonary atresia
EXPLANATION
Vascularisation of the lungs can only be judged on a good quality chest x-ray in newborns. In pulmonary atresia the vascularisation of the lungs is decreased, pulmonary circulation is duct-dependent. The heart is usually not enlarged. In A and B, the configuration of the heart can be characteristic and vascularisation is increased.
PED - 6.3
One of these statements does not apply to an isolated ventricular septal defect in the newborn.
A) the left-to-right shunt increases with time
B) can lead to decompensation
C) there could be signs of pulmonary congestion
D) it always causes cyanosis, which disappears later
ANSWER
D) it always causes cyanosis, which disappears later
EXPLANATION
There is no cyanosis in an isolated ventricular septal defect in the newborn. Due to the higher pulmonary vascular resistance, the left-to-right shunt is not pronounced in the early phase, but will increase with time. Typical signs and symptoms would be present by 2-3 months of age. If the defect is big, decompensation can develop with signs of pulmonary congestion.
PED - 6.4
A newborn showing signs of congestive heart failure has easily palpable upper extremity pulses, but the pulse can not be felt on the lower extremities. What is the most likely diagnosis?
A) hypoplastic left heart syndrome
B) severe, „critical” valvular aortic stenosis
C) coarctation of the aorta
ANSWER
C) coarctation of the aorta
EXPLANATION
Severe coarctation of the aorta can lead to circulatory decompansation in the newborn. If the ductus arteriosus is not widely open, the lower extremity pulse cannot be palpated. There is severe decompansation in hypoplastic left heart syndrome, but usually there is not a great difference in the pulses (they are usually weak everywhere). In severe (critical ) valvular aortic stenosis, the pulses are weak both in the upper and the lower part of the body
PED - 6.5
Which of the following maternal diseases increase the risk of congenital heart defect in the fetus?
1) alcoholism
2) phenylketonuria
3) Type 1-diabetes mellitus
4) hyperthyreoidism
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
There is an increased risk of congenital heart defect in the fetus if the mother drinks alcohol during the pregnancy (fetal alcohol syndrome can develop), or has certain metabolic diseases (e.g phenylketonuria, insulin dependent diabetes mellitus). Maternal hyperthyreosis can have an impact on the fetal circulation, but would not cause a congenital heart defect.
PED - 6.6
Which of the following can be a sign of a congenital heart defect?
1) heart murmur
2) pulse difference
3) central cyanosis
4) heart failure
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
E) All of the answers are correct
EXPLANATION
All these four can be manifestations of a congenital heart defect- in combination or alone. The congenital heart defect itself will determine which symptom is characteristic of the given disorder.
PED - 6.7
Cardiac cause(s) of chest pain:
1) coronary artery malformation
2) tachy-arrhythmia
3) pericarditis/myocarditis
4) cardiac decompensation
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
Malformations of the coronary arteries can lead to ischemia, which causes chest pain. In tachyarrhythmias, the diastolic filling of the heart is compromised, which causes shortness of breath and an uncomfortable feeling (dyscomfort). In peri/myocarditis it is the inflammation of the pericardium or the accumulation of the pericardial fluid which leads to pain. Decompensation in itself does not cause chest pain.
PED - 6.8
Which of the following can be a sign/symptom of tetralogy of Fallot?
1) cardiac decompensation
2) cyanosis
3) tachypnea
4) polycythemia
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
C) Answers 2 and 4 are correct
EXPLANATION
Tetralogy of Fallot belongs to the cyanotic group of congenital heart defects, cyanosis and hypoxia increase the red blood cell production and can cause polycythemia. Decompensation is uncommon in Fallot. Bounding pulses are characteristic of the patent ductus arteriosus.
PED - 6.9
In which of the following heart defects is it necessary to keep the ductus arteriosus open?
1) transposition of the great arteries
2) pulmonary atresia
3) critical coarctation of the aorta
4) common arterial trunk
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
Keeping the ductus arteriosus open can be life-saving in the following situations: enhancing the mixture of the blood between the two otherwise separate circulations in transposition of the great arteries; or if the normal anterograde flow to the pulmonary (e.g pulmonary atresia) or the systemic circulation (e.g critical coarctation of the aorta) is not possible and the blood supply must come from the other circulation through the duct.
PED - 6.10
Cardiac examinations which would cause radiation exposure:
1) CT-angiography
2) Cardiac MRI
3) cardiac catheterization
4) echocardiography
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
B) Answers 1 and 3 are correct
EXPLANATION
CT-angiography and angio-catheterization are examinations with x-ray-load (the latter needs contrast material in general). Cardiac MRI and ultrasound (echocardiography) do not involve exposure to irradiation.
PED - 6.11
Synchronized cardiversion can effectively stop the following rhythm disturbancy (-ies):
1) atrial ectopic tachycardia
2) atrial flutter
3) pulseless Torsades de pointes tachycardia
4) atrioventricular reentry tachycardia (AVRT)
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
C) Answers 2 and 4 are correct
EXPLANATION
Synchronized cardioversion can be effective in arrhythmias due to a reentry circuit, such as atrial flutter and atrioventricular reentry tachycardia (AVRT). If the arrhythmia is due to an ectopic focus, cardioversion is ineffective (atrial ectopic tachycardia or ventricular extrasystole, which in most cases originate from an ectopic focus).
PED - 6.12
A bolus of adenosin can stop the following rhythm disturbancy(-ies):
1) Atrial flutter
2) Atrial fibrillation
3) Ventricular tachycardia
4) Atrioventricular reentry tachycardia
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
D) Only answer 4 is correct
EXPLANATION
Adenosine is effective in those rythm disturbancies, where the AV node is involved in the mechanism. Adenosine temporarily blocks the conduction of the AV node. Only atrioventricular reentry tachycardia fulfills this criteria of this list.
PED - 6.13
Cardiac decompensation can cause the following in children:
1) loss of apetite
2) tachypnea
3) hepatomegaly
4) edema of the ankles
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
In children common symptoms of heart failure include the following: loss of apetite, tachypnea (congestion of the lungs), hepatomegaly (congestion of the liver). Ankle or pretibial edema are unlikely in children (but are common in adults!)
PED - 6.14
Characteristic of the AV reentry tachycardia:
1) The pulse gradually increases at the beginning of the episode and gradually decreases at the end
2) during the tachycardia the R-R distance is variable
3) never occurs under 1 year of age
4) adenosine can stop it
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
D) Only answer 4 is correct
EXPLANATION
In atrioventricular reentry tachycardia there is a sudden onset and sudden cessation of the tachycardia, the R-R distance is constant (regular tachycardia). The peak age is infancy, when an accessory pathway is likely to be present. Thus the first three answers are incorrect. The AV reentry tachycardia can be terminated with adenosine, because the AV node is a part of the pathologic circuit.
PED - 6.15
Tetralogy of Fallot constitutes of:
1) Big subaortic ventricular septal defect
2) Aorta overriding the ventricular septal defect
3) Right ventricular outflow tract obstruction
4) Right ventricular hypertrophy
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
E) All of the answers are correct
EXPLANATION
Tetralogy of Fallot (as the name implies) consists of 4 characteristic disorders of the heart. These are the four listed in the test. The common origin is a malformation of the infundibulum of the right ventricular outflow tract.