Rita's Cardiac Questions

Question 1

Physiological splitting of the S2 sound is:

a) normal
b) indicates need for ecg
c) suggestive of ASD
d) indicates a need for cardiac referral

Answer 1

a) normal

Question 2

A grade 2/6 musical murmur of the LLSB, which gets louder when lying down indicates:

a) A VSD
b) Still’s Murmur
c) Venous hum
d) Pulmonic stenosis

Answer 2

b) Still’s murmur

Question 3

You are seeing a 9yo with BP >95%. What is the next step in the management of this patient?

a) Repeat the BP within a week
b) Do a complete set of electrolytes
c) Do a urinalysis
d) Start on a low salt diet

Answer 3

a) Repeat the BP within a week

Question 4

What are the characteristics of venous hum?

a) increases when the child lies down
b) heard best at the upper sternal border
c) heard best at the right upper sternal border
d) heard best at the mitral area

Answer 4

c) heard best at the right upper sternal border

Question 5

What is the characteristic of a venous hum?

a) increases when the child lies down
b) disappears with the turn of the neck
c) disappears when squatting
d) disappears with hand fisting

Answer 5

b) disappears with the turn of the neck

Question 6

While examining an asymptomatic six month old with a loud systolic murmur heard best at LLSB. What is the most likely dx?

a) VSD
b) ASD
c) PDA
d) Tetralogy of Fallot

Answer 6

a) VSD

Question 7

A child comes in with decreased femoral pulses. What is the most likely reason?

a) VSD
b) Aortic regurgitation
c) Coarctation of the aorta

Answer 7

c) Coarctation of the aorta

Question 8

Which are not included in the criteria for the diagnosis of Kawasaki disease?

a) lymphadenopathy
b) fever
c) heart murmur
d) polymorphous rash

Answer 8

c) heart murmur

Question 9

What is the tx for joint pain in acute rheumatic fever?

a) naproxen
b) steroids
c) Tylenol
d) Penicillin

Answer 9

a) naproxen

Question 10

Which of the following children with chest pain would be the least concerning to the PNP?

a) an 18yo w/mitral valve prolapse
b) a 5yo with a hx of kawasaki disease
c) a 7yo with an aortic stenosis
d) a 12yo with Marfan’s syndrome

Answer 10

a) an 18yo w/mitral valve prolapse

- -> most benign

Question 11

A 13yo has intermittent, sharp, and left radiating chest pain for 2 days. The pain is reproducible on palpation of the LUSB. The hx is remarkable for an innocent murmur at 3yo. What is the best approach?

a) Reassure
b) Refer to cardiology
c) Refer to ED

Answer 11

a) Reassure

??? unsure if this is correct answer!!

Question 12

In doing a cardiac exam, where do you hear the S1?

a) ULSB or pulmonic area
b) Mitral area
c) LLSB or tricuspid area
d) Aortic area

Answer 12

b) Mitral area

Question 13

Where is the normal place to hear the second heart sound?

a) ULSB or pulmonic area
b) Mitral area
c) LLSB or tricuspid area
d) Aortic area

Answer 13

d) Aortic area

Question 14

You are examining a well 3yo with a II/VI systolic murmur at LLSB. The murmur is not radiating and the PE is normal. What is the next best step?

a) Refer to cardiology
b) Feel it is a functional murmur
c) Feel it is a VSD

Answer 14

b) Feel it is a functional murmur

- -> Still’s…

Question 15

A child presents with wide pulse pressure with low diastolic BP. You think this is:

a) normal
b) indicative of an aortic regurgitation
c) indicative of a VSD
d) indicative of an ASD

Answer 15

b) indicative of an aortic regurgitation

- -> wide pulse pressure! (ex: in old people w/aortic valve disease, feel bounding pulse)

Question 16

Which is the most concerning issue discovered during the pre-participation sports physical of a 14yo Hispanic male?

a) Pt hx of left tibia fracture 2 years ago
b) Failed vision screen: 20/80 bilaterally
c) Small, reducible left inguinal hernia
d) Sudden death of a maternal uncle at 35yo

Answer 16

d) Sudden death of a maternal uncle at 35yo

Question 17

A 2yo with an unrepaired tetralogy is here with congestive heart failure. What sx are NOT necessarily indicative of CHF?

a) edema
b) tachycardia
c) tachypnea
d) irritabliity

Answer 17

d) irritabliity

unprepared tetralogy: kid will be blue.
–> Sacral edema in kids

Question 18

The most common congenital heat defect in children is:

a) ASD
b) VSD
c) PDA
d) tricuspid atresia

Answer 18

b) VSD

Question 19

The most common cause of myocarditis is:

a) Virus
b) Drug reaction
c) bacterial infection
d) post chemotherapy

Answer 19

a) Virus

- -> Coxsackie B

Question 20

Primary hypertension without any precipitating disease is most common in:

a) infants
b) preschool children
c) children who are 6-10
d) adolescents

Answer 20

d) adolescents

Question 21

The most useful test for the evaluation of acute rheumatic fever is:

a) Antistreptolysin-O titer
b) Electrocardiogram
c) Hemoglobin electrophoresis
d) CBC with diff

Answer 21

a) Antistreptolysin-O titer

Question 22

Which of the following diagnostic test should be done with a child with suspected Kawasaki disease?

a) an echocardiogram
b) CMP
c) CBC
d) Anti-streptolysin-O titer

Answer 22

a) an echocardiogram

Kawasaki = dx of exclusion!

Question 23

What is the most common cause of acquired coronary heart disease in the US?

a) Rheumatic fever
b) Hypertension
c) Systemic lupus erythematous
d) Kawasaki disease

Answer 23

d) Kawasaki disease

Question 24

Which of the following is most likely to cause secondary hypercholesteremia?

a) Kawasaki disease
b) Corticosteroids
c) Nephrotic syndrome
d) Congenital heart disease

Answer 24

c) Nephrotic syndrome

- -> sky-high cholesterol

Question 25

Which is NOT a sign of extreme stress in a family with a chronically ill child? a) older kid's grades start slipping b) parents stop attending their support group c) mom provides all of the sick kid's care d) dad gets a second job to alleviate financial problems e) occasionally forgetting medication

Answer 25

e) occasionally forgetting medication

Question 26

You are doing a pre participation sports physical. Which of the following would be the most worrisome? a) inguinal hernia b) acne c) an aunt that died suddenly at age 39 d) vision screen of 20/100

Answer 26

c) an aunt that died suddenly at age 39

Question 27

Which of the following requires a cardiology referral? a) A 4yo with a grade 4/6 murmur heard at the right USB which disappears with supine position b) a 2yo with 2/6 musical murmur at LLSB c) A 14yo with 3/6 systolic ejection murmur best heard in the pulmonic area d) A 1 yo with harsh 2/6 mid to late ejection USB murmur with click and radiation

Answer 27

a) A 4yo with a grade 4/6 murmur heard at the right USB which disappears with supine position - -> cardiomyopathy AND d) A 1 yo with harsh 2/6 mid to late ejection USB murmur with click and radiation - -> pulmonic or aortic valve disease a 2yo with 2/6 musical murmur at LLSB = Still's A 14yo with 3/6 systolic ejection murmur best heard in the pulmonic area = pulmonic outflow murmur

Question 28

A 2yo has a 4 day hx of fever, erythema of lips, soles, hands, with strawberry tongue, cervical lymph node involvement, and conjunctivitis sparing the limbus. What is the most likely dx? a) Scarlet fever b) Kawasaki disease c) Rheumatic fever d) Group a Beta hemolytic strep infection

Answer 28

b) Kawasaki disease

Question 29

You are counseling parents of an infant with congestive heart failure about feeding. What is an impt need of the infant? a) Increased calories b) Increased fluids c) Decreased fats d) Decreased protein

Answer 29

a) Increased calories