Cardiology

Question 1

What are switched in transposition of the great arteries?

Answer 1

Pulmonary artery and aorta - the aorta arises from the RV and PA from the LV

Question 1

What does survival in transposition of the great arteries depend upon?

Answer 1

A shunt being also present - PDA, ASD, VSD. If there is no shunt, there is no mixing of systemic and peripheral circulations

Question 2

Describe the presentation of transposition of the great arteries

Answer 2

Cyanosis at birth/ within 24 hours, tachycardia, respiratory distress, sweating, poor feeding and weight gain

Question 3

What does the CXR show for transposition of the great arteries?

Answer 3

Eggs on a string - narrow mediastinum and cardiomegaly

Question 4

What is the gold standard diagnosis for transposition of the great arteries?

Answer 4

ECHO

Question 5

What is given to maintain the ductus arteriosus?

Answer 5

Prostaglandin infusion

Question 6

Name 3 causes of infective endocarditis

Answer 6

Strep viridans (dental work), staph aureus (IV DU), staph epidermis (prosthetic heart valves)

Question 7

What does FROM JANE stand for in IE?

Answer 7

Fever, Roth spots, Osler nodes, Murmur (new), Janeway lesions, anaemia, nails (splinter haemorrhages) and emboli

Question 8

What is the gold standard diagnosis for IE?

Answer 8

Echo shows vegetation on the pulmonary valve

Question 9

Describe the treatments for IE dependent on cause

Answer 9

IV ben pen for strep, IV fluclox for staph aureus and IV amox for unknown

Question 10

What is rheumatic fever?

Answer 10

A type 2 hypersensitivity reaction that can occur 2-4 weeks after strep pyogenes infection (tonsilitis)

Question 11

What is an atrial septal defect?

Answer 11

A hole in the septum between the two atria connecting left and right sides causing a left to right shunt

Question 12

What is the most common form of ASD?

Answer 12

ostium secondum

Question 13

What is the murmur of ASD?

Answer 13

Mid systolic crescendo-decrescendo murmur loudest at the upper left sternal border

Question 14

What is a ventricular septal defect?

Answer 14

A hole in the septum between the two ventricles

Question 15

What is often underlying in VSD?

Answer 15

A genetic condition such as Downs or Turners

Question 16

What is the murmur of VSD?

Answer 16

Pansystolic murmur heard loudest at the left lower sternal border in the 3rd and 4th intercostal spaces

Question 17

Name the 4 co-existing pathologies of tetralogy of fallot

Answer 17

Pulmonary Valve Stenosis, Right Ventricular Hypertrophy, Overriding Aorta and VSD

Question 18

What is the overall direction of the Tetralogy of Fallot shunt?

Answer 18

right to left

Question 19

What are tet spells?

Answer 19

Periods where the shunt worsens when pulmonary vascular resistance increases or systemic decreases causing a cyanotic episode

Question 20

What is shown on CXR for T of F?

Answer 20

Boot shaped heart

Question 21

What is the gold standard management for T of F?

Answer 21

total surgical repair via open heart surgery

Question 22

What is PDA?

Answer 22

Persistent connection between aorta and pulmonary artery which normally closes permanently within 2-3 weeks

Question 23

How does PDA present?

Answer 23

SOB, difficulty feeding, poor weight gain, tachypnoea, lower RTI

Question 24

What is the murmur of PDA?

Answer 24

Continuous machinery murmur crescendo-decrescendo

Question 25

What can be given in PDA to inhibit prostaglandin?

Answer 25

Indomethacin

Question 26

What is Eisenmenger Syndrome?

Answer 26

Blood flows from the right side of the heart to the left across a structural heart lesion, bypassing the lungs causing by PDA, ASD, VSD

Question 27

What is aortic valve stenosis?

Answer 27

Narrow aortic valve restricting blood flow from LV to aorta. The aortic valve normally has 3 leaflets called the aortic sinuses of Valsalva

Question 28

What is the presentation of AVS?

Answer 28

Mild can be asymptomatic More significant - fatigue, SOB, dizziness, fainting, worse on exertion

Question 29

What is the murmur of AVS?

Answer 29

Ejection systolic loudest at the aortic area with an ejection click

Question 30

What is the presentation of heart failure?

Answer 30

Sweating, SOB, poor weight gain and feeding, tachypnoea, hepatomegaly, cardiomegaly, tachycardia, gallop rhythm and older children can present with adult signs such as raised JVP, oedema and paroxysmal nocturnal dyspnoea

Question 31

What is the most common abnormal rhythm in children?

Answer 31

supraventricular tachycardia

Question 32

What does ECG of SVT show?

Answer 32

Narrow complex tachycardia of 250-300 bpm

Question 33

What is the treatment for SVT?

Answer 33

Carotid sinus massage, IV adenosine and maintenance with solatol or flecanide

Question 34

What is Wolff Parkinson White?

Answer 34

Pre-excitation syndrome due to abnormal re-entry circuit of the AV node accessory pathway (Bundle of Kent)

Question 35

What does the ECG of Wolff Parkinson White show?

Answer 35

Short PR interval and delta wave

Question 36

What is the definitive management of Wolff Parkinson White?

Answer 36

Catheter ablation of the extra pathway

Question 37

What is long QT syndrome?

Answer 37

Autosomal dominant - causes blackouts and palpitations

Question 38

What is the most common cardiac defect in babies of diabetic mothers?

Answer 38

Transposition of the great arteries