CARDIOLOGY Flashcards by Verona Coralie Desulme

Newborn with cyanosis, pulse oximetry changed
from 60% to 64% only on 100% oxygen

Cardiac (most likely)

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Newborn with cyanosis, pulse oximetry changed
from 60% to 88% on 100% O2

Pulmonary (most likely)

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What is the reason that left to right shunt lesions may not present until 1 month of age?

The pulmonary vascular resistance drops to
normal levels at that time

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A 1-day-old infant with a history of maternal
diabetes, cyanosis, and tachypnea, poor response to supplemental oxygen, loud single second heart sound, no murmur, chest radiograph shows narrow mediastinum with small heart tipped on side, increased pulmonary vascularity

Transposition of great vessels

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What is the next best step in a newborn with
suspected transposition of the great vessels?

Prostaglandin E1 to keep the patent ductus
arteriosus (PDA) open, followed by +/− balloon
atrial septostomy and surgery

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The most common cause of cyanotic heart disease presenting a few days after birth

Transposition of the great vessels

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Newborn presents with cyanosis in the lower
extremities, tachycardia, respiratory distress, and loud single S2 sound

Persistent pulmonary hypertension (R→L
shunting across the PDA)

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A 1-day-old newborn presents with cyanosis,
single first and second heart sounds, chest
radiograph, shows decreased lung markings, and electrocardiogram shows left axis deviation

Tricuspid atresia with pulmonary atresia

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Newborn presents with cyanosis (mother was on a medicine for severe bipolar disorder), chest radiograph shows cardiomegaly and right atrial enlargement

Ebstein anomaly

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Newborn presents with severe cyanosis, systolic
ejection murmur, and a single second heart sound, chest radiograph shows decreased pulmonary vascular markings

Severe pulmonary stenosis

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Newborn presents with intense cyanosis and
respiratory distress, chest radiograph shows a
“snowman” shaped heart

Supracardiac total anomalous pulmonary venous return

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An 8-week-old boy presents with feeding
difficulties, poor weight gain, episodes of bluish
discoloration of the skin while feeding and crying, a harsh systolic ejection murmur (SEM) is heard over the pulmonic area and left sternal border; chest radiograph shows diminished vascularity in the lungs and diminished prominence of the pulmonary arteries, a boot-shaped heart (coeur en sabot)

Tetralogy of Fallot

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During the first 48 h of life, a newborn rapidly
develops cyanosis, tachypnea, respiratory distress, pallor, lethargy, metabolic acidosis, oliguria, weak pulses in all extremities, hepatosplenomegaly, and no murmur

Hypoplastic left heart (as PDA closes)

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A 2-year-old with a history of tetralogy of Fallot
has progressive agitation, increasing cyanosis, and increased fussiness

Hypercyanotic spell (Tet spell)—next step is the
knee-chest position

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What is the next best step for the newborn in the previous case with suspected hypoplastic left heart?

Prostaglandin E1

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A 2-week-old boy develops congestive heart
failure, severe metabolic acidosis, and poor
perfusion of the lower extremities

Coarctation of the aorta

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Newborn presents with shock; the echocardiogram shows coarctation of the aorta. What is the drug of choice?

Prostaglandin E1

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A 12-year-old presents with hypertension,
occasional headache, leg cramps, weak and
delayed femoral pulse, and blood pressure in the upper limb is higher than the lower limb, chest radiograph shows rib notching and scalloping on the undersurface of posterior ribs

Coarctation of the aorta

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Newborn presents with shock; the echocardiogram shows coarctation of the aorta. What is the drug of choice?

Prostaglandin E1

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Coarctation of the aorta

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A girl with Turner syndrome presents with
hypertension, weak and delayed femoral pulse

Coarctation of the aorta

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Newborn infant presents with a soft, harsh systolic ejection murmur, best heard at the axillae, and precordium and no symptoms

Peripheral pulmonary stenosis (PPS)

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Newborn infant presents with a soft, harsh systolic ejection murmur, best heard at the axillae, and precordium and no symptoms

Peripheral pulmonary stenosis (PPS)

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The most common cardiac lesion associated with trisomy 21 (Down syndrome)

Endocardial cushion defect O. I. Naga

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The most common cardiac lesion associated with Turner syndrome

Bicuspid aortic valve

The most common cardiac lesion associated with trisomy 18

Ventricular septal defect (VSD)

The most common cardiac lesion associated with Williams syndrome

Supravalvar aortic stenosis

The most common cardiac lesion associated with Noonan syndrome

Pulmonary stenosis

The most common cardiac lesion associated with DiGeorge syndrome

Tetralogy of Fallot

The most common cardiac lesion associated with Alagille syndrome

Branch pulmonary stenosis

The most common cardiac lesion associated with cri du chat syndrome

VSD

The most common cardiac lesion associated with Holt–Oram syndrome

Atrial septal defect (ASD)

The most common cardiac lesion in fetal alcohol syndrome

VSD, ASD

The most common cardiac lesion associated with lithium teratogen

Ebstein anomaly

The most common cardiac lesion associated with supraventricular tachycardia

Ebstein anomaly

The most common cardiac lesion associated with the infant of a diabetic mother

Ventricular hypertrophy

The most common cardiac lesion associated with tuberous sclerosis

Cardiac rhabdomyoma

The most common valvular lesion associated with acute rheumatic fever

Mitral regurgitation

The most common cardiac lesion associated with Marfan syndrome

Aortic root dilation (risk for dissection)

The most common congenital cardiac lesion overall

VSD

The syndrome that is associated with true interrupted aortic arch

DiGeorge syndrome

Adolescent routine physical exam, apical midsystolic non-ejection click, and late systolic murmur; the murmur is louder when goes from a supine to a standing position, and the murmur becomes softer when squatting

Mitral valve prolapse

Child routine physical exam, systolic murmur with a vibratory character, best heard in the lower sternal border, varies with changes in respiration and position

Still’s murmur

A 6-year-old with a continuous murmur, lowpitched sound, best heard in the infraclavicular region, disappears when supine and with gentle pressure on the jugular vein

Venous hum

While having her hair brushed, a 15-year-old girl develops cold sweats, pallor, and palpitations and loses consciousness for 10 s

Vasovagal syncope

While running, a 15-year-old girl lost consciousness

Thorough cardiac evaluation and referral to a cardiologist

The most common cause of sudden cardiac death in an athlete

Hypertrophic cardiomyopathy

Newborn fails hearing screen; EKG shows a very prolonged QT interval

Jervell and Lange-Nielsen syndrome

A 5-year-old, heart rate is 230 beats/min, chest discomfort; the heart rate decreases to 80 beats/ min after ice is applied to the face

Supraventricular tachycardia (SVT)

A 15-year-old girl faints while running and has a positive family history of deafness and sudden death

Long QT syndrome

What is the definitive treatment for SVT?

Radiofrequency ablation

Child presents with a history of intermittent tachycardia; EKG shows a short PR interval, slurred and slow rise of the initial upstroke of QRS (delta wave), widened QRS complex

Wolff–Parkinson–White syndrome (WPW)

Child presents with chest pain, fever, friction rub; EKG shows diffuse ST-segment elevation, had upper respiratory infection 10 days before

Pericarditis

Adolescent diagnosed with influenza presents with fever, tachycardia, edema, and gallop; chest radiograph shows pulmonary edema, cardiomegaly, low-voltage EKG

Myocarditis

An athlete presents with dyspnea while playing; systolic ejection crescendo-decrescendo murmur best heard at the apex and left sternal border, and radiates to the suprasternal notch; the murmur is louder while standing and with Valsalva maneuver

Hypertrophic cardiomyopathy

A football player presents with chest pain with exertion and several near syncope episodes during his football game. Next best step?

Restrict from sports then EKG and echocardiogram

EKG in a 12-day-old shows negative T wave in V6

Left ventricular hypertrophy

A 15-year-old boy with a history of recurrent chest pain during exercise faints and dies while playing basketball; hypertrophic cardiomyopathy ruled out as a cause of death. What is the next likely cause?

Anomalous left coronary artery is most likely

What is the most common organism responsible for infective endocarditis in pediatric patients with or without congenital heart disease?

Staphylococcus aureus

History of repaired VSD with a small residual VSD next to the VSD patch, going in for dental work. Is subacute bacterial endocarditis (SBE) prophylaxis indicated?

Antibiotic prophylaxis

Child with prosthetic mitral valve going for surgery; is SBE prophylaxis indicated?

Antibiotic prophylaxis

Child with mitral regurgitation and VSD, going in for dental work. Is SBE prophylaxis indicated?

No antibiotic prophylaxis

Child with a previous history of endocarditis; is SBE prophylaxis indicated?

Antibiotic prophylaxis

A mildly desaturated child with tetralogy of Fallot going in for dental work; is SBE prophylaxis indicated?

Antibiotic prophylaxis

Tall, peaked T waves in precordial leads indicates

Hyperkalemia

An infant of diabetic mother presents a few hours after birth with jitteriness, hypoglycemia, cyanosis; EKG shows prolonged QT interval

Hypocalcemia

EKG shows sinus tachycardia, widened QRS complex with an interval greater than 100 ms, in a child who presents with altered mental status after accidentally ingesting grandmother’s medication

Tricyclic antidepressant (TCA) toxicity

EKG shows normal PR intervals and periodic drop in QRS

Type II second degree AV block (Mobitz II)

EKG shows progressive prolongation of PR interval followed by a drop in QRS

Type I second degree AV block (Mobitz I or Wenckebach)

A 6-month-old infant with failure to thrive, diaphoresis, and hepatomegaly. Echocardiogram shows a large VSD. Next best step?

Surgical correction

An asymptomatic adolescent with blood pressure 137/87, all labs normal, renal US and chest radiograph normal. What is the next best step?

Salt restriction in diet

A late complication of an untreated ASD or VSD that results in desaturation

Eisenmenger syndrome—shunt becomes a right to left shunt

A 4-year-old boy with physical examination significant for widely split and fixed S2 and crescendo-decrescendo systolic ejection murmur heard in the second intercostal space at the upper left sternal border. EKG shows a RSR1 pattern in V1. What is the most likely diagnosis?

Atrial septal defect

A premature infant with a continuous machine-like murmur and bounding pulses

PDA

Which medication is used to close a PDA in a premature infant?

Indomethacin

What are some common side effects of indomethacin?

Thrombocytopenia GI bleeding Necrotizing enterocolitis Renal failure

Systolic murmur most commonly heard at the right upper sternal border radiates to the neck and is associated with an ejection click

Aortic stenosis

Most common valve abnormality associated with aortic stenosis

Bicuspid aortic valve

What is the most likely etiology of an early highpitched diastolic murmur associated with bounding pulses in a patient with Marfan syndrome?

Aortic regurgitation

High-pitched holosystolic blowing murmur heard loudest at the apex and radiates to the axilla

Mitral valve regurgitation

What is the most feared complication of Kawasaki disease?

Coronary artery aneurysm

Late crescendo systolic murmur associated with a mid-systolic click, may be seen in adolescents

Mitral valve prolapse

Late diastolic rumbling murmur with an opening snap heard at the apex

Mitral valve stenosis

A 10-year-old male presents with sharp chest pain; the pain is reproducible on physical exam

Costochondritis

An 8-year-old presents with sharp stabbing nonspecific chest pain at rest that resolves shortly. There are no other symptoms and no past medical history

Reassurance (precordial catch syndrome)

At what ages is lipid screening universally recommended in the pediatric population?

Once between 9 and 11 and again between 17 and 21

What is the initial management for an obese adolescent with elevated cholesterol levels?

Diet and lifestyle modifications, and if cholesterol is still elevated after 6 months, then start statin

CARDIOLOGY Flashcards

(87 cards)