Cardiology

Question 1

What are the most important perinatal history questions?

Answer 1

Were they healthy while they were pregnant?

Did they receive prenatal care?

US during pregnancy? if so, did they show anything?

Maternal infections?

Maternal Medications?

Question 2

What maternal infections are pertinent to a infant cardiac work up for cardiology?

Answer 2

TORCH infections
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes

Question 3

What maternal medications are pertinent to an infant cardiac work up for cardiology?

Answer 3

Phenytoin
Lithium
Retinoic acid
Warfarin

(all associated with cardiac malformations)

Question 4

What is a good way to word palpitations when talking to a child?

Answer 4

Have you had any extra beats or skipped beats

Question 5

What are you looking for during palpation on cardiac exam

Answer 5

Are they hyperdynamic?

Displaced point of maximal impact?

Do you feel a thrill?

Question 6

What pulses should you be feeling for in an infant during a cardiac exam?

Answer 6

Brachial
lower femoral pulses

Are they bounding?
Is there a difference between upper and lower pulses?

Question 7

What blood pressures should be taken on an infant for cardiac examination? why?

Answer 7

Upper and a lower to make sure there is no gradient

A systolic BP >10mm Hg higher in the arm vs leg may signify a coarctation of the aorta

Question 8

S1 is the sound of what valves closing?

Answer 8

Mitral (M1) and Tricuspid (T1)

Question 9

S2 is the sound of what valves closing?

Answer 9

Aortic (A2) and Pulmonic (P2)

Question 10

Splitting of S2 is normal in children to hear during variation with _______

Answer 10

Respirations

Question 11

Widely split S2 can be indicative of what? (2 things listed)

Answer 11

Volume overload
Electrical delay (R bundle branch block)

Question 12

Narrowly split S2 can be indicative of what? (2 things listed)

Answer 12

Pulmonary HTN

Aortic stenosis

Question 13

Entirely single S2 can be indicative of what? (2 things listed)

Answer 13

Severe aortic stenosis

Severe Pulmonary HTN

Question 14

What areas do you auscultate on the heart

Answer 14

Aortic
Pulmonic
Tricuspid
Mitral

Question 15

What grade murmur?

Barely audible

Answer 15

Grade I/VI

Question 16

What grade murmur?

Soft but easily audible

Answer 16

Grade II/VI

Question 17

What grade murmur?

Moderately loud but no thrill

Answer 17

Grade III/VI

Question 18

What grade murmur?

Loud and accompanied by a thrill

Answer 18

Grade IV/VI

Question 19

What grade murmur?

Audible with stethoscope barely on chest

Answer 19

Grade V/VI

Question 20

What grade murmur?

Audible with stethoscope off the chest

Answer 20

Grade VI/VI

Question 21

A Ejection systolic murmur

Usually can be caused by what 2 things

Answer 21

Pulmonary stenosis

Aortic stenosis

Question 22

A late systolic murmur

Usually caused by

Answer 22

Mitral valve prolapse

Question 23

Holosystolic murmurs are usually caused by what? (3)

Answer 23

Tricuspid regurgitation
mitral regurgitation
Ventricular septal Defect

Question 24

Crescendo/decrescendo murmur is what

softer, louder, softer

Answer 24

Midsystolic (Ejection systolic murmur)

remember…this can be from Pulmonary stenosis or
Aortic stenosis

Question 25

This murmur is heard throughout systole between S1 and S2 and can often obscure the beginning of diastole

Answer 25

Holosystolic Murmur remember these are usually caused by Tricuspid regurgitation mitral regurgitation Ventricular septal Defect

Question 26

Short regurgitant murmur. Heard right at the beginning of systole

Answer 26

Early systolic murmur

Question 27

Murmur that is Usually reflective of mitral regurgitation and are usually accompanied by a mitral click

Answer 27

Late systolic murmur

Question 28

What type of murmurs are always pathologic

Answer 28

Diastolic

Question 29

Early Diastolic Murmur Higher pitched Radiates to the apex What causes this?

Answer 29

Aortic Regurgitation

Question 30

Early Diastolic Murmur Higher pitched Radiates along the left sternal border What causes this?

Answer 30

Pulmonary Regurgitation

Question 31

Mid- Diastolic Murmur Lower pitched Best heard with bell of stethoscope heard at the apex What causes this?

Answer 31

Mitral stenosis

Question 32

Mid- Diastolic Murmur Lower pitched Best heard with bell of stethoscope heard at the left lower sternal border What causes this?

Answer 32

Tricuspid stenosis

Question 33

Causes of continuous murmurs

Answer 33

PDA AV fistula Shunt murmur post -surgery Venous hum

Question 34

A venous hum murmur varies with patient position in what way?

Answer 34

louder when they are sitting with neck extended and softer or absent with the rotation of the neck or when they are supine.

Question 35

where are you going to hear aortic stenosis, what type of murmur?

Answer 35

``` Aortic area (Right upper sternal border) A Ejection systolic murmur ```

Question 36

Murmur heard in the Left upper sternal border

Answer 36

Pulmonary Murmurs

Question 37

Murmur usually heard along the apex

Answer 37

Mitral murmurs

Question 38

what murmurs are heard at the left lower sternal border

Answer 38

Tricuspid area VSD Tricuspid regurgitation Stills murmur

Question 39

which murmur has a characteristic vibratory quality and is typically louder when they are supine rather than sitting

Answer 39

Still's murmur

Question 40

Gallops are heard during what heart sounds

Answer 40

S3, S4

Question 41

S3 Gallop is best heard at the _____ if produced by a dilated or dysfunctional left ventricle

Answer 41

Apex

Question 42

S3 Gallop is best heard at the _____ if produced by dilated or dysfunctional R ventricle

Answer 42

Left sternal border

Question 43

Are S3 gallops always pathological

Answer 43

no, it can be normal in children and young adults or reflective of dilated ventricles and decreased compliance

Question 44

Are S4 Gallops always pathological

Answer 44

yes

Question 45

S4 heart sounds are heard best at

Answer 45

Apex

Question 46

An S4 heart sound are usually associated with

Answer 46

decreased ventricular compliance that occurs with myocardial ischemia or ventricular hypertrophy

Question 47

3 types of clicks

Answer 47

Ejection clicks Mid-systolic click Diastolic opening snap

Question 48

Ejection click is best heard where and is reflective of what

Answer 48

Apex Aortic stenosis or Bicuspid aortic valve

Question 49

Mid systolic clicks are heard where and are reflective of what

Answer 49

Apex | mitral valve prolapse

Question 50

Diastolic opening snaps are heard where and reflective of what

Answer 50

Apex or Left lower sternal border | Mitral stenosis

Question 51

This is heard when the 2 walls of the pericardium rub against each other, producing audible friction which sounds like grating, scratching or rasping. Systolic and diastolic components Best heard between the apex and the sternum

Answer 51

Pericardial friction rub

Question 52

where is Pericardial friction rub best heard

Answer 52

between the apex and the sternum

Question 53

What is Pericardial friction rub usually indicative of

Answer 53

Pericarditis

Question 54

Most common congenital heart defect

Answer 54

VSD

Question 55

3 stenotic defects

Answer 55

Aortic stenosis Pulmonary stenosis Coarctation of the aorta

Question 56

Defects that have Right to Left shunting

Answer 56

Tetralogy Transposition Tricuspid atresia

Question 57

Defects that have Left to right shunting

Answer 57

Patent ductus arteriosus VSD ASD

Question 58

Defects that have mixing

Answer 58

Truncus TAPVR HLH

Question 59

Initial treatment for moderate to large VSDs

Answer 59

Diuretics, some providers use Digoxin and/or afterload reduction if they continue to have poor growth or pulmonary HTN, they may require surgical closure

Question 60

3 types of ASDs and where are they located

Answer 60

secundum defect - hole in the region of the foramen ovale (most common) Primum ASD - near the endocardial cushions Sinus venosus defect - associated with anomalous pulmonary venous return

Question 61

What murmur might I be? Loud pansystolic heard best at the Lower left sternal border may be a thrill Large shunting may cause a mid-diastolic murmur at the apex The splitting of S2 and intensity of P2 depend on the pulmonary artery pressure

Answer 61

VSD