Cardiology

Question 1

most congenital heart defects are a result of problems with ..

Answer 1

either septation, rotation, or migration

Question 2

two classification of congenital heart dz

Answer 2

1. acyanotic (left to right shunt)

2. cyanotic (right to left shunt)

Question 3

2 broad categories of cyanotic CHD

Answer 3

1. intra-cardiac defects and obstruction to pulmonary flow

2. admixture of pulmonary and systemic venous return

Question 4

Physical findings for CHD

Answer 4

1.cyanosis (need 5 mg/dl of de ox blood
2. if anemic, it might be hidden
3. check both upper and lower extremities saturation
4. arterial pulse - absent, bounding, delayed
5-heart sound-S2 split or not, fixed split, murmurs

Question 5

innocent murmur

Answer 5

• Still’s murmur is a musical/vibratory systolic LSB, not in back, decreased w/expiration/standing
• Physiologic peripheral pulmonic stenosis which is a soft harsh SEM best heard in axillae bilaterally and disappears by 12 MONTHS
• venous hum

Question 6

Phyisiologic peripheral pulmonic stenosis is a soft harsh SEM best heard in

Answer 6

axillae BILATERALLY

Question 7

venous hum is a/w

Answer 7

innocent murmur

Question 8

…is a musical/vibratory systolic LSB, not in back, decreased w/expiration/standing

Answer 8

Still’s murmur

Question 9

List acyanotic CHD.

Answer 9

PDA, ASD, VSD, atrioventricular canal, coarctation of aorta

Question 10

most common of all CHD

Answer 10

VSD

Question 11

murmur in VSD

Answer 11

holosystolic @LLSB, loud if restrictive

Question 12

PE findings in large VSDs

Answer 12

failure to thrive, tachypnea, GERD

Question 13

most common defect in down syndrome

Answer 13

VSD

Question 14

lab findings in VSD

Answer 14

ECG: LVH
CXR: cardiomegaly, increased pulmonary vascular markings
Echo: location, size. pressure gradient, other defects
Cath: if unclear of size and sx , indications for surgery

Question 15

VSD medical managements

Answer 15

diuretic, ACE, digoxin

Question 16

indication for surgery in VSD

Answer 16

1. unmanageable HF
2. failure to med mostly due to failure to thrive, URI, pneumonia
3. shunt greater than 1.5-2 w/wo sx

Question 17

most common type of ASD

Answer 17

secundum ASD

Question 18

2nd most common CHD

Answer 18

ASD

Question 19

risk of paradoxical emboli is a/w

Answer 19

ASD

Question 20

sx of ASD

Answer 20

usually asx, fatigue, palpitation, exercise intolerance

Question 21

never leave ASD open in … pts

Answer 21

young girls approaching puberty

Question 22

development of eisnmenger’s is a risk for what CHD

Answer 22

ASD

Question 23

synonyms of Atrioventricular Septal Defects (AVSD)

Answer 23

endocardial cushion defects, atrioventricular canal defects (AVCD)

Question 24

types of AVSD

Answer 24

1. complete : a.common AV valve b. primum ASD c. inlet VSD

2. Partial: MOST FREQUENT FORM = primum ASD +cleft anterior MV leaflet

Question 25

most common prenatal dx of CHD

Answer 25

AVSD

Question 26

AVSD is very common with ...what trisomy

Answer 26

21 -down syndrome ---usually the complete form

Question 27

AVSD with Tetralogy almost unique to what trisomy

Answer 27

21-down syndrome

Question 28

complete AVSD usually results in

Answer 28

PA HTN, CHF

Question 29

complete AVSD vs Partial AVSD

Answer 29

Complete: Large ASD & Large VSD Partial: Large ASD & no VSD

Question 30

repair of partial VSD at what age?

Answer 30

delayed until after 18-24 mos old

Question 31

problems a/w partial VSD

Answer 31

subaortic stenosis and LAVV regurgitation or stenosis

Question 32

PDA leads to enlarged ...

Answer 32

RA, RV, LV

Question 33

PDA signs and sx

Answer 33

Continuous machinery murmur, wide pulse pressure, hyperdynamic precordium

Question 34

PDA closure approaches

Answer 34

medical: indomethacin, ibuprofen catheter based: coil, device surgical: left thoractomy

Question 35

three surgical method for closure of PDA

Answer 35

1. clip-premees 2. ligate-neonates, infants, young children 3. divide and oversew-toddlers and older

Question 36

coarctation of aorta

Answer 36

juxtaductal just distal or at left subclavian artery

Question 37

signs and sx a/w coarctation of aorta

Answer 37

proximal hypertension-pressure differential | murmur- systolic, LUSB and left interscapular may be continuous

Question 38

murmur in coarctation of aorta

Answer 38

systolic, LUSB and left interscapular may be continuous

Question 39

coarctation of aorta is a/w what syndrome

Answer 39

turner's syndrome

Question 40

presentation of coarctation of aorta in infants

Answer 40

irritability, tachypnea, poor feeding, FTT, CHF

Question 41

presentation of coarctation of aorta in older children and teens

Answer 41

HA, nosebleed, absent/diminished femoral pulses, unexplained HTN

Question 42

rib-notching is a/w

Answer 42

coarctation of aorta

Question 43

lab findings in coarctation of aorta

Answer 43

ECG: LVH CXR: cardiomegaly, rib-notching (takes several years to develop) Echo: useful but difficult to visualize but diagnostic CT-angio/MRA : gold standard

Question 44

gold standard dx for coarctation of aorta

Answer 44

CT-angio/MRA

Question 45

tx of coarctation of aorta

Answer 45

surgical (stent is reserved for recurrent coarctations)

Question 46

cyanotic CHD

Answer 46

truncus arteriosus, transposition, tetralogy of fallot, TAPVR

Question 47

truncus arteriosus

Answer 47

- common truncus-failure to septate into aorta and pulmonary artery - large VSD with right to left shunt - CHF with diastolic runoff

Question 48

DiGeorge syndrome is a/w

Answer 48

truncus arteriosus

Question 49

when to repair truncus arteriosus?

Answer 49

first 2 weeks of life

Question 50

transposition of great vessels (dTGA)

Answer 50

aorta and PA did not rotate

Question 51

transposition of great vessels (dTGA)

Answer 51

cyanotic, coronary anomalies, | PGE started BAS performed - need adequate mixing

Question 52

gold standard for dTGA repair

Answer 52

arterial switch operation-true anatomic repair done in first 2 weeks of life

Question 53

"egg on a string appearance " on CXR is a/w

Answer 53

dTGA

Question 54

tetralogy of fallot

Answer 54

1. Right Ventricular Outflow Tract obstruction -infundibular often with valvar and supravalvur stenosis 2. VSD 3. overriding aorta 4. RVH

Question 55

when to fix TOF?

Answer 55

by 3-6 months or sooner if blue

Question 56

TAPVR

Answer 56

Total Anomalous Pulmonary Venous Connection

Question 57

most common cyanotic heart anomaly

Answer 57

TOF

Question 58

murmur in TOF

Answer 58

crescendo-decrescendo holosystolic at LSB radiating to back

Question 59

murmur in d-TGA

Answer 59

systolic if associated VSD

Question 60

cyanosis that alleviated with squatting is a/w

Answer 60

TOF

Question 61

differences btw arterial pulses and BP in UE and LE is pathognomonic for ...

Answer 61

coarctation of aorta

Question 62

boot shaped heart (coeur en sabot) is a/w

Answer 62

TOF

Question 63

most common site of coarctation of aorta

Answer 63

ligamentum arteriosum

Question 64

wide fixed split SD is a/w

Answer 64

ASD

Question 65

loud S2 is a/w

Answer 65

dTGA