Cardiology

Question 1

Hypoplastic left heart murmur and surgery

Answer 1

ejection systolic LSE

Norwood –> Glenn –> Fontan

Question 2

DiGeorge cardiac issues

Answer 2

ToF
aortic arch abnormalities

Question 3

AVRT

Answer 3

WPW
SVT <8yo

Question 4

AVNRT

Answer 4

SVT >8yo

Question 5

tachy and HF after Coxsackie?

Answer 5

viral myocarditis

Question 6

acute management of SVT

Answer 6

vagal
IV adenosine near heart
sync DCCV

Question 7

maintenance of SVT

Answer 7

flecainide
sotalol
verapamil

Question 8

ECG sizes

small squares
PR
QTc

Answer 8

small squares = 0.04s
PR = 0.12-0.2s (3 to 4)
QTc = 0.35-0.45s (8 to 11)

Question 9

long QT syndromes

Answer 9

Jervell = hearing loss, AR
Romano = no hearing loss, AD

Question 10

ASD features

Answer 10

2ICS left
systolic murmur
fixed split S2 (doesn’t vary with breathing as RV is always overloaded)

ECG - long PR, RBBB, R axis deviation

fix when pul:sys is 2:1

Question 11

secondum ASD IE risk

Answer 11

none

Question 12

Janeway vs Osler lesions

Answer 12

Janeway are painless
Oslers are painful

Question 13

Major criteria for IE

Answer 13

BC or echo

Question 14

chorea is associated with

Answer 14

rheumatic fever

Question 15

PDA definitions and treatment

Answer 15

> 3/12 if prem, >1yr if term

coil if term
ibuprofen if preterm
paracetamol if renal impairment, thrombocytopaenia or NED

Question 16

HOCM inheritance and signs

Answer 16

AD

triple ripple precordial motion
systolic murmur between apex and left sternal edge, radiating to suprasternal not h but not carotids (mitral valve due to awkward papillary muscle insertion)
louder with Valsalva, quieter with squatting

Question 17

ToF spells

Answer 17

pul stenosis spasm
murmur quietens
R to L shunt (cyanotic)

Question 18

gallop rhythm

Answer 18

HF/pul oedema

Question 19

dx test for IE

Answer 19

3 blood cultures

Question 20

prophylaxic abx in sickle cell

Answer 20

pencillin (or erythromycin) from 3m-5yo

Question 21

follow up for sickle cell

Answer 21

• annual transcranial doppler for >2yo
• annual U+E and bp
• 2-3 yearly eye checks (annual if retinopathy)

Question 22

small vessel vasculitis

Answer 22

HSP

Question 23

medium vessel vasulitis

Answer 23

Kawasaki

Question 24

SVT decompenasated

Answer 24

1) sync DCCV at 1 then 2 J/kg with IM/IV/nasal ketamine
2) adenosine if suitable IV access and delay to shock
3) amiodarone before 3rd shock

Question 25

VT with shock

Answer 25

Sync DCCV

Question 26

VT with unconsciousness

Answer 26

Sync DCCV Consider amiodarone before 3rd shock

Question 27

Not sure if SVT or VT

Answer 27

treat as VT

Question 28

Bradycardia algorithm

Answer 28

1) oxygenation 2) CPR 3) atropine if vagal stimulation likely cause 4) adrenaline 5) pacing

Question 29

SVT compensated

Answer 29

1) vagal manoeuvre 2) adenosine

Question 30

Non shockable arrest

Answer 30

1) CPR with adrenaline asap 2) adrenaline 10mcg/kg every 3-5 mins

Question 31

Shockable arrest

Answer 31

1) 4J/kg unsync DCCV asap 2) after 3 shocks give adrenaline 10mcg/kg then every other cycle 3) after 3rd and 5th shocks give amiodarone 5mcg/kg

Question 32

Criteria for diagnosis of rheumatic fever

Answer 32

evidence of strep AND 2 major OR 2 minor and 1 major

Question 33

Major criteria for rheumatic fever

Answer 33

J - joint involvement <3 - carditis N - nodules E - erythema marginatum S - Sydenhams chorea

Question 34

Minor criteria for rheumatic fever

Answer 34

R - rheumatic fever previously A - arthralgia C - CRP H - heat (fever) E - ESR L - long PR interval

Question 35

bounding pulses

Answer 35

PDA

Question 36

suprasternal notch thrill

Answer 36

aortic stenosis HOCM

Question 37

carotid thrill

Answer 37

aortic stenosis

Question 38

parasternal heave

Answer 38

RVH usually due to VSD