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Royal College Exam > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Inheritance of long QT syndrome

A

autosomal dominant!
homozygous = Jervell Lange-Neilson (assoc with sensorineural hearing loss)
heterozygous = Romano-Ward

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2
Q

Treatment of long QT

A

avoid exercise, beta-blockers

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3
Q

What is the axis on ECG of a child with an AVSD?

A

left-axis deviation

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4
Q

in what congenital heart disease would you see left axis deviation?

A

AVSD, small RV (tricuspid atresia), Noonan syndrome (no clear reason why…)

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5
Q

what are the signs on ECG of LV hypertrophy

A

Tall R waves in V6, deep S waves in V1

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6
Q

ECG signs of RV hypertrophy

A

Tall R waves in V1, deep S waves in V6, Q waves in V1, upright T waves in V1 (after day 5 of life - should be flipped until about age 9)

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7
Q

Palivizumab - what is it

A

monoclonal IgG antibody against RSV

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8
Q

recurrence rate of congenital heart disease

A

4% up to 10% (higher if left-sided)

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9
Q

Complications of Fontan

A

protein-losing enteropathy, plastic bronchitis

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10
Q

What cardiac patients need antibiotic prophylaxis?

A

those with a high risk lesion (Cyanotic, repaired with prosthetic material in last 6 months, persistent defects - leak) undergoing a high risk procedure (dental procedure, non-infected gut/GU procedure)

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11
Q

ECG findings - pericarditis

A

diffuse ST elevation, PR depression, T wave flattening eventually T wave inversion

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12
Q

Main cause of CHF - first week of life

A
  • obstructions! hypoplastic left heart (d3-5), severe aortic stenosis, coarctation (d7-10)
  • asphyxia
  • uncontrolled tachycardia (SVT >24hrs)
  • severe mitral/tricuspid regurgitation
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13
Q

Main cause of CHF - week 2-6 of life

A

Things that cause left to right shunting: VSD, AVSD, PDA

NOT ASD!

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14
Q

Main cause of CHF - older children

A

pump failure!

dilated cardiomyopathy, myocarditis, tachycardia

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15
Q

3 signs of CHF in infants

A

tachycardia, tachypnea, hepatomegaly

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16
Q

Risk of recurrence of congenital heart disease (isolated case) in sib?

A

2-3%

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17
Q

CHD in Turner syndrome (name 3)

A
  • coarctation of the aorta, bicuspid aortic valve, aortic stenosis
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18
Q

CHD in fetal alcohol syndrome (name 3)

A

VSD, ASD, TOF

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19
Q

CHD in VACTERL

A

ASD, VSD, PDA (65-85%)

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20
Q

CHD in Trisomy 13 (patau) - name > 3

A

PDA, VSD, ASD, valvular disease, coarctation of the aorta, complex defects

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21
Q

CHD in Trisomy 18

A

VSD, polyvalvular disease (~100%)

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22
Q

Duct dependent for pulmonary circulation CHD

A
  • pulmonary atresia, critical pulmonary stenosis, pulmonary atresia with intact septum, TOF
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23
Q

Duct dependent for systemic circulation CHD

A

Severe aortic stenosis, interrupted aortic arch, hypoplastic left heart syndrome

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24
Q

CHD - duct required for “mixing”

A

TGA

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25
Q

Most common type of ASD? (primum, sinus venosus, secundum) and ECG finding

A

secondum, right anterior deviation on ECG

26
Q

Most common congenital heart disease and CXR finding

A

VSD, 14-18%

CXR - increased pulmonary vasculature, cardiomegaly

27
Q

Most common CHD in T21

A

AVSD

28
Q

What is bicuspid aortic valve associated with?

A

5-8% also have coarcation

29
Q

Noonan syndrome CHD (name 2)

A

pulmonary stenosis w/ dysplastic pulmonary valve, hypertrophic cardiomyopathy

30
Q

Alagille syndrome CHD

A

peripheral pulmonary stenosis

31
Q

Physical exam and CXR findings of coarctation of aorta

A

shock, hypertension, murmur, ejection click (assoc with bicuspid valve), weak/delayed femoral pulses, BP gradient (upper/lower extremities), rib notching on cxr (due to collateral vessels going to descending aorta)

32
Q

AVSD ECG finding

A

Left-ward and superior axis on ECG

33
Q

Auscultation of aortic stenosis

A

Systolic ejection murmur at right upper sternal border, ejection click

34
Q

Tetralogy of Fallot

A
  • VSD
  • overriding aorta
  • pulmonary stenosis
  • right ventricular hypertrophy
35
Q

X-ray with “wall to wall” heart

A

tricuspid regurgitation

36
Q

What CHD to think about with tricuspid regurgitation

A

Ebstein’s anomaly!

37
Q

Rhythm abnormalities with Ebsteins

A

WPW

38
Q

Initial management of TGA

A
  • prostaglandin to keep duct open, balloon atrial septostomy
39
Q

3 types of CHD associated with 22q11

A

common arterial trunk, tetralogy, interrupted aortic arch

40
Q

Complications of Fontan

A
  • arrhythmias
  • cyanosis
  • protein losing enteropathy
  • plastic bronchitis
  • thromboembolism
41
Q

TAPVD - clinical findings and x-ray

A
  • cyanosis, respiratory distress

- xray: snowman (only in supracardiac), increased pulmonary vasculature (venous blood stuck in pulmonary circulation)

42
Q

What CHD should you NOT use PGE in?

A

TAPVD - increases pulmonary blood flow

43
Q

Medical management of TAPVD

A

NONE!

44
Q

Features of innocent heart murmurs

A

soft (gr II or less), normal heart sounds, quiet precordium, along sternal border, varies with position

45
Q

Diastolic murmur heard in…

A

aortic or pulmonary valve regurgitation, AV valve stenosis

46
Q

Pathologic systolic ejection murmur heard in…

A

aortic/pulmonic valve stenosis, ASD, coarctation

47
Q

pansystolic murmur

A

VSD, AVVR (mitral, tricuspid)

48
Q

continuous murmur

A

runoff lesions (PDA, AVM, aortopulmonary collaterals, BT shunt)

49
Q

carditis of rheumatic fever

A

endomyocarditis with valvulitis involving the MITRAL and aortic valves

50
Q

management of rheumatic fever associated carditis

A

mild = ASA, severe = prednisone

51
Q

secondary prevention of rheumatic fever

A
  • Pen G IM Q3-4wks
  • Pen V PO 250 mg BID

if no carditis - 5 yrs or 21 yrs old (whichever is longest)

if carditis - 10 yrs or 25 yrs of age

if carditis with valve involvement - at least 40 yrs or life-long

52
Q

clinical features of pericarditis

A

sharp, stabbing precordial pain; worse when supine, better leaning forward (pain = referred from diaphragm/pleura); friction rub on auscultation; ECG = diffuse ST elevation

53
Q

Cardiac findings in Pompe disease

A
  • hypertrophic cardiomyopathy, increased wall thickness, supraventricular tachycardia, short PR interval, very high QRS voltages
54
Q

What is Jervell and Lange-Nielsen syndrome?

A

Long QT + sensorineural deafness, autosomal recessive (homozygous)

55
Q

Unexplained nocturnal death in a structurally normal heart - what syndrome?

A

Brugada syndrome

56
Q

Leading cause of acquired heart disease in childhood

A

Kawasaki disease

57
Q

Greatest risk of developing aneurysms in KD

A
  • male gender
  • young age (<6mos)
  • not treated with IVIG
58
Q

Emergency treatment of VT

A

synchronized cardioversion, IV lidocaine, IV amiodarone, correct underlying etiology, others - procainamide, magnesium

59
Q

Definition of pulmonary hypertension

A

mean pulmonary arterial pressure > 25 mmHg at rest

60
Q

ECG change in acute rheumatic fever

A

prolonged PR

61
Q

A/E of adenosine

A

atrial fibrillation

62
Q

A/E of PGE1

A

apnea
hypotension
fever
edema

Royal College Exam (32 decks)

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