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1. pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

[Cardiology/PE/murmur]

Affects of maneuvers to Hypertrophic Cardiomyopathy

Valsalva: ___
Standing: ___
Passive leg raise: ___
Handgrip: ___

A

Valsalva (dec LV filling): increase murmur
Standing (dec VR): increase murmur
Passive leg raise (inc VR): decrease murmur
Handgrip (inc PVR): decrease murmur

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2
Q

[Cardiology/PE/murmur]

Affects of maneuvers to Mitral Valve Prolapse

Valsalva: ___
Handgrip: ___

A

Valsalva: Click moves earlier
Handgrip: Click moves later

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3
Q

[Cardiology/PE/murmur]

Which murmur?

Soft, musical quality, systolic
Louder in supine, anemia, or fever
Softer with standing, Valsalva

A

Innocent murmurs

(HCM murmur increases with standing, valsalva)

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4
Q

[Cardiology/EKG]

Normal durations of intervals

PR: ___
QRS: ___
QTc: ___ % of RR
- < 15 years: ___
- > 15 years: ___

A

PR: 1 big square, 200 ms
QRS: 1/2 big square, 100 ms
QTc: ~40% of RR
- < 15 years: 460 ms
- > 15 years: men 450 ms, women 460 ms

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5
Q

[Cardiology/arrhythmia/WPW]

Treatment of choice for A-fib or A-flutter with WPW?

A

IV Procainamide

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6
Q

[Cardiology/arrhythmia/WPW]

Treatment of choice for stable VT?

A

Amiodarone

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7
Q

[Cardiology/anti-arrhythmics]

Which anti-arrhythmic side effect?

Torsades de pointes, dairrhea, autoimmune thrombocytopenic purpura
Cichonism: hearing loss, tinnitus, psychosis

A

Quinidine (Class Ia)

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8
Q

[Cardiology/anti-arrhythmics]

Which anti-arrhythmic side effect?

Agranulocytosis, neutropenia, thrombocytopenia
Drug-induced SLE: fever, arthralgia, pericarditis

A

Procainamide (Class Ia)

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9
Q

[Cardiology/anti-arrhythmics]

Which anti-arrhythmic side effect?

If used chronically,

Corneal deposits
Hepatic toxicity
Hyper/hypothyroidism, hepatic toxicity
Pulmonary fibrosis
Gray skin, sun sensitivity

A

Amiodarone (Class III)

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10
Q

[Cardiology/arrhythmia/long QT]

Congenital long QT syndrome differentiation

Romano-Ward syndrome:
- Autosomal ____
- Without or With sensorineural hearing loss

Jervell and Lange-Nielsen syndrome:
- Autosomal ____
- Without or With sensorineural hearing loss

A

Romano-Ward syndrome:

  • Autosomal Dominant
  • Without sensorineural hearing loss

Jervell and Lange-Nielsen syndrome:

  • Autosomal Recessive
  • With sensorineural hearing loss
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11
Q

[Cardiology/arrhythmia/AV block]

2 degree AV block
- PR Prolongation and drop: Mobitz ___, treatment: ___
- Periodical drop: Mobitz ___, treatment: ___

A

2 degree AV block

  • PR Prolongation and drop: Mobitz 1, treatment: no
  • Periodical drop: Mobitz 2, treatment: pacemaker (if symptomatic)
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12
Q

[Cardiology/arrhythmia]

Causes of this EKG (3)?

A

3rd degree AV block

  • Infant of mother with SLE
  • Lyme carditis
  • Hyperkalemia
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13
Q

[Cardiology/arrhythmia]

Most common cause of this EKG?

A

RBBB

  • Open-heart surgery
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14
Q

[Cardiology/CHD]

Associated congenital heart diseases?

Lithium: ___
Ethanol: ___
Antiseizure: ___
Retinoic acid: ___
Diabetes: ___
Lupus: ___

A

Lithium: Ebstein anomaly
Ethanol: ASD, VSD
Antiseizure: PS, AS, TOF
Retinoic acid: transposition
Diabetes: HCM
Lupus: complete heart block

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15
Q

[Cardiology/CHD]

Associated congenital heart diseases?

Noonan: ___
Alagille: ___
William: ___
Turner: ___
22q11.2: ___

A

Noonan: PS
Alagille: PS
William: Supravalvular AS
Turner: CoA, bicuspid AV
22q11.2: Truncus arteriosus, interrupted aortic arch, TOF

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16
Q

[Cardiology/CHD/LtR/VSD]

Most common type of VSD

  • < 1 years old: ___
  • > 1 years old: ___
A
  • < 1 years old: muscular septum
  • > 1 years old: perimembranous septum
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17
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease and treatment?

At 3-4 weeks of age
Sx: FTT, frequent respiratory infection
M: Holosystolic murmur with thrill at LLSB
CXR: increased pulmonary vasculature
EKG: LVH, if prolonged RVH

A

Ventricular septal defect

Treatment:

  • If asymptomatic, wait till 6 months
  • If symptomatic and perimembranous or muscular: medical therapy and surgery 3-5 years old
  • If symptomatic and large: surgery
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18
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease and treatment by age?

Premature infants
M: Rumbling, machinery like, at left clavicle, radiate to the back
PE: Bounding pulses, wide pulse pressure
CXR: cardiomegaly, increased pulmonary markings
ECG: LVH

A

Patent ductus arteriosus

Treatment:

  • Infants: ibuprofen, indomethacin
  • Older: catheter, surgery
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19
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease, and its type and treatment age?

Sx: Most asymptomatic, HF > 20-30 years of age if undiagnosed
Female>Male
M: Systolic cresendo decrescendo, wide fixed S2, at LUSB, mid-diastolic murmur
CXR: right atrium, ventricle, pul artery enlargement
ECG: RAD, RVH, rsR’ or rSR’

A

Atrial Septal Defect
Ostium Secundum Defect

Treatment:

  • Closure by 5 years of age
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20
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease, and its type and treatment age?

Sx: HF < 5 years of age
M: cresendo decresendo, wide fixed S2, at LUSB
CXR: right atrium, ventricle, pul artery enlargement
ECG: LAD, RVH

A

Atrial Septal Defect
Ostium Primum Defect
(Partial AV defect)

Treatment:

  • Surgical correction ≤ 1-2 years old
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21
Q

[Cardiology/CHD/LtR]

Which Congenital heart disease and treatment age?

Sx: HF by 2 months old
M: Holosystolic at LLSB, mid-diastolic at apex
ECG: severe LAD, biventricular hypertrophy
CXR: cardiomegaly, increased pulmonary flow
Associated with Down syndrome

A

Complete AV canal defect

Treatment:

  • Surgical correction < 6 months
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22
Q

[Cardiology/CHD/RtL/TOF]

4 components of tetralogy of Fallot

A
  1. VSD
  2. RV outflow tract obstrction (PS or subpulmonic stenosis)
  3. Overriding aorta
  4. RVH
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23
Q

[Cardiology/CHD/RtL/TOF]

For Tetralogy of Fallot

Worsening cyanosis: ___
Improving cyanosis: ___

A

Worsening cyanosis:

  • Increase PVR (Valsalva, screaming)
  • Decrease SVR (eating, heat)

Improving cyanosis:

  • Increase SVR (squatting)
  • Decrease PVR (calming down)
24
Q

[Cardiology/CHD/RtL/TOF]

Medical treatment for Tetralogy of Fallot?

Acute: ___
Tet preventive: ___

A

Acute:

  • Oxygen: decrease PVR
  • β-blocker: decrease HR, increase RV filling
  • Morphine: decrease HR

Tet Preventive:

  • Propranolol
25
Q

[Cardiology/CHD]

Typical CXR finding:

CoA: ___
Ebstein: ___
TOF: ___
TGA: ___
TAPVR: ___

A

CoA: figure 3
Ebstein: box-like
TOF: boot-shaped
TGA: egg-shaped
TAPVR: snowman

26
Q

[Cardiology/CHD/RtL/TOF]

Associated genetic syndrome with Tetralogy of Fallot (3)?

A
  1. Trisomies, 21, 13 and 18
  2. Alagille syndrome
  3. CHARGE syndrome
27
Q

[Cardiology/CHD/LtR]

Acyanotic heart disease (Left to Right shunt) (4)?

A
  1. VSD
  2. ASD, PFO
  3. PDA
  4. Complete AV canal defect
28
Q

[Cardiology/CHD/RtL]

Cyanotic heart disease (Right to Left shunt) (4)?

A
  1. TOF
  2. TGA
  3. Tricuspid Atresia
  4. Pulmonary atresia with intact ventricular septum
29
Q

[Cardiology/CHD/LtR]

Cyanotic heart disease (Other mixing) (3)?

A
  1. Truncus Arteriosus
  2. TAPVR
  3. HLHS
30
Q

[Cardiology/CHD/RtL]

Which Congenital heart disease and acute treatment?

Sx: Cyanosis in the few hours of life
PE: single loud S2, no murmur (or VSD murmur later)
ECG: positive T wave in V1 (RVH)
CXR: egg-shaped

A

Transposition of the Great Arteries

Acute management:

  • PGE1
  • ballon atrial septostomy
31
Q

[Cardiology/CHD/RtL]

Which Congenital heart disease?

Sx: Cyanosis in the few hours of life
M: VSD or PS murmur
EKG: Left Superior axis (0 to -60) deviation, LVH

A

Tricuspid Atresia

TA: Superior axis (0 to -60) / PA: Inferior (0 to 90) axis

32
Q

[Cardiology/CHD/Cyanotic]

Which Congenital heart disease?

Sx: Cyanosis in the few hours of life
M: no murmur
EKG: Left Inferior axis (0 to 90) deviation, LVH

A

Pulmonary atresia with intact ventricular septum

TA: Superior axis (0 to -60) / PA: Inferior (0 to 90) axis

33
Q

[Cardiology/CHD/Mixing]

Which Congenital heart disease?

Sx: HF in the first few weeks of life
M: hyperdynamic, single S2, ejection click
CXR: Cardiomgaly
EKG: RVH, biventricular hypertrophy
Associated with DiGeorge syndrome

A

Truncus arteriosus

(Needs FISH test for 22q11 deletion)

34
Q

[Cardiology/CHD/Mixing]

Which Congenital heart disease?

Sx: Tachypnea, FTT
Or pulmonary edema, severe cyanosis
CXR: snowman

A

Total Anomalous Pulmonary Venous Return (TAPVR)

35
Q

[Cardiology/CHD/Mixing]

Which congenital heart disease, type doesn’t respond to PGE1?

A

TAPVR, infradiaphragmatic form

36
Q

[Cardiology/CHD/Mixing]

Which Congenital heart disease?

Sx: Acute HF in the first few weeks
M: no murmur, loud S2,
PE: poor pulses, hyperdynamic RV, gray color
CXR: cardiomegaly, pulmonary edema
ECG: RA, RV hypertrophy

A

Hypoplastic Left Heart Syndrome

37
Q

[Cardiology/CHD/Obst]

Which heart disease?

Sx: Shock in a few weeks of life
M: Harsh systolic ejection murmur at RUSB, Click at apex
PE: All pulses diminished, low BP
CXR: cardiomegaly, pul edema
EKG: LVH, LV strain (ST depression in left lateral)

A

Aortic stenosis

38
Q

[Cardiology/CHD/Obst]

Which heart disease?

Sx: Cyanosis in infancy
M: ejection click after 1st HS, systolic, at LUSB, radiating to left clavicle, back,
EKG: peaked P waves (RA enlargement), RAD, RVH
CXR: RV prominence

A

Pulmonary stenosis

39
Q

[Cardiology/CHD/Obst]

Which heart disease?

Sx: HF, pulmonary edema in infancy
M: apical systolic
ECG: broad P waves (LA enlargement), RVH
Associated with rheumatic fever

A

Mitral stenosis

40
Q

[Cardiology/CHD/Obst]

Which heart disease and treatment?

Sx: Dyspnea on exertion, chest pain, syncope, sudden death in athletes
M: systolic, cresendo-decresendo, at LMSB, louder with Valsalva, softer with squat
ECG: LVH, negative T in V6

A

Hypertrophic cardiomyopathy
(AS murmur gets louder with squat)

Treatment:

  • β-blocker for maintenance
  • myectomy if severe
41
Q

[Cardiology/CHD/Regurg]

Causes of aortic regurgitation (4)?

A

Bicuspid aortic valve (Turner)
Marfan
RF
Infective endocarditis

42
Q

[Cardiology/PE/Murmur]

RUSB: ___
LUSB: ___
L, 3rd ICS: ___
LLSB: ___
Apex: ___

A

RUSB (Aortic)
- Systolic: AS, flow murmur

LUSB (Pulmonic):
- Systolic: PS, ASD, flow murmur

LL 3rd ICS (Erb):
- Diastolic: AR, PR
- Systolic: HCM

LLSB (Tricuspid):
- Holosystolic: VSD, TR
- Diastolic: TS

Apex:
- Systolic: MR, MVP
- Diastolic: MS

43
Q

[Cardiology/CHD/Regurg]

Conditions associated with Mitral Valve Prolapse (4)?

A

Marfan
Ehlers-Danlos
Mucopolysaccharidosis
Anorexia nervosa

44
Q

[Cardiology/RF]

Jones criteria for Rheumatic Fever (5)?

A

Joint (polyarthritis, migratory)
♡ Carditis
Nodules, subcutaneous
Erythema marginatum
Sydenam Chorea

45
Q

[Cardiology]

___ bodies are pathognomic for ___
(Palisading giant cells with areas of swelling, granulomatous inflammation in cardiomyocytes)

A

Aschoff bodies are pathognomic for Rheumatic Fever

46
Q

[Cardiology/RF]

Serologic test for Rheumatic fever (5)?

A

Anti streptolysin O (ASO)
Anti-deoxyribonuclease B (anti-DNase B)
Anti-hyaluronidase
Anti-streptokinase
Anti-nicotinamide adenine dinucleotidase (anti-NADase)

47
Q

[Cardiology/IE Prophylaxis]

Disease indication for infective endocarditis prophylaxis (4)?

A
  1. Prosthetic (mechanical and bio) cardiac valve, completely repaired CHD with prosthetics for 6 months postprocedure
  2. Previous history of endocarditis
  3. Unrepaired cyanotic heart disease, Repaired CHD with residual lesion
  4. Cardiac transplant with cardiac valvulopathy
48
Q

[Cardiology/IE Prophylaxis]

Procedure indication for infective endocarditis prophylaxis (3)?

A
  1. Dental
  2. Respiratory
  3. Infected skin
    (Not for GU or GI)
49
Q

[Cardiology/IE Prophylaxis]

Choice of antibiotics for infective endocarditis prophylaxis?

A

PO: Amoxicillin (Standard) once 1 hour before procedure
IV: Ampicillin
(If allergic, clindamycin, cephalexin)

50
Q

[Cardiology/CM]

Which cardiomyopathy and treatment?

Sx: infants, toddlers with fatigue, shortness of breath, ankle swelling
PE: low BP, weak pulses, increased HR and RR, elevated jugular pulses

A

Dilated cardiomyopathy

Treatment

  • Diuretics and ACEi
51
Q

[Cardiology/Pericardial]

Diagnosis and treatment?

Following open ASD repair (or other surgical repair)
Pericardial friction rub, muffled heart sound, fever
Increased ESR

A

Postpericardiotomy syndrome

Treatment:

  • Aspirin
52
Q

[Cardiology/HF]

Timing of HF presentation

1st week of life: ___
4-8 weeks of life: ___
6-8 years of life: ___

A

1st week of life: left heart obstruction (CoA, HLHS)
4-8 weeks of life: L to R shunt (VSD, AVSD)
6-8 years of life: acquired (RF, myocarditis)

53
Q

[Cardiology/HF/Treatment]

Side effects?

Preload reduction: diuretics
1. Loop diuretics: furosemide
2. Cortical diluting: thiazides, metolazone
3. K-sparing: Spironolactone

A

Preload reduction: diuretics
1. Loop diuretics: furosemide

  • hypokalemia, hypochloremia, hyponatremia, metabolic alkalosis
    2. Cortical diluting: thiazides, metolazone
  • hypokalemia, hypercalcemia, hyperuricemia, hyperlipidemia
    3. K-sparing: Spironolactone
  • hyperkalemia (Esp with ACEi), gynecomastia
54
Q

[Cardiology/HF/Treatment]

Both vasopressor and inotropic (3)
Vasopressor (3)
Inotropic (3)

A

Both vasopressor and inotropic

  • Epinephrine, Norepinephrine, Dopamine

Vasopressor (3)

  • Vasopressin, Angiotensin, Phenylephrine

Inotropic (3)

  • Milrinone, Isoproterenol, Dobutamine
55
Q

[Cardiology/HF/Treatment]

Afterload reduction: Vasodilators (3)

A
  1. ACEis
  2. Sodium Nitroprusside
  3. β-blocker
56
Q

[Cardiology/arrhythmia]

Treatment for long QT syndrome

A

Mild: Propranolol
Mod to severe: ICD (implantable cardioverter-defibrillator)

1. pediatrics (22 decks)

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