Cardiology

Question 1

What are 3 causes of ejection systolic murmur?

Answer 1

1) Aortic stenosis
- URSE
- louder on EXpiration
- radiates to carotids
- ± click, paradoxical split S2

2) Pulmonary stenosis
- ULSE
- louder on INspiration
- radiates to back
- ±click, widened split S2

3) Atrial septal defect
- ULSE
- soft murmur
- fixed split S2

Question 2

What are the characteristics of an aortic stenosis murmur?

Answer 2

1) Ejection systolic murmur
2) URSE
3) Louder on expiration
4) Radiated to carotids
5) Slow rising pulse
6) ± click, paradoxical split S2

Question 3

What are the characteristics of a pulmonary stenosis murmur?

Answer 3

1) Ejection systolic murmur
2) ULSE
3) Louder on INspiration
4) Radiates to back
5) Widened split S2
6) ±click

Question 4

What are the characteristics of atrial septal defect murmurs?

Answer 4

1) Soft ejection systolic murmur
2) ULSE
3) Fixed split S2

Question 5

What 3 causes of pansystolic murmurs?

Answer 5

1) VSD
- pansystolic
- LLSE
- ± MDM (large)

2) Tricuspid regurg
- pansystolic
- LLSE
- blowing
- louder on INspiration

3) Mitral regurg
- pansystolic
- apex
- blowing
- radiates to axilla

Question 6

What are the characteristics of a VSD murmur?

Answer 6

1) pansystolic
2) LLSE
3) ± MDM (large)

Question 7

What are the characteristics of a tricuspid regurgitation murmur?

Answer 7

1) pansystolic
2) LLSE
3) blowing
4) louder on INspiration

Question 8

What are the characteristics of a mitral regurgitation murmur?

Answer 8

1) pansystolic
2) apex
3) blowing
4) radiates to axilla

Question 9

What is the tetralogy of fallot?

Answer 9

Most common cyanotic congenital heart disease
1) Pulmonary stenosis
2) RV hypertrophy
3) Overriding aorta
4) VSD

Question 10

How is a “tet” spell managed?

Answer 10

1) Calm
2) Knee to chest/ squat
3) O2
4) Morphine
5) ß-blocker

Question 11

What is a tet spell?

Answer 11

acute, severe hypoxemia from ↑R→L shunting
- 2° to ↑pulmonary pressure and thus RV pressure (eg. crying/ stress)

Question 12

What are the causes of diastolic heart murmurs?

Answer 12

1) Aortic regurg
- EDM
- URSE
- blowing
- louder on Expiration
- radiates to apex
- bounding pulse

2) Pulmonary regurg
- EDM
- ULSE
- blowing
- louder on INspiration
- radiates to LLSE

3) Tricuspid stenosis
- MDM
- LLSE
- low pitched rumble
- louder on INspiration
- high-pitched opening snap

4) Mitral stenosis
- MDM
- apex
- low pitched rumble
- high pitched opening snap

Question 13

What are the characteristics of an aortic regurgitation murmur?

Answer 13

1) EDM
2) URSE
3) Blowing
4) Louder on EXpiration
5) Radiates to apex
6) Bounding pulse

Question 14

What are the characteristics of a pulmonary regurgitation murmur?

Answer 14

1) EDM
2) ULSE
3) Blowing
4) Louder inspiration
5) Radiates to LLSE

Question 15

What are the characteristics of a tricuspid stenosis murmur?

Answer 15

1) MDM
2) LLSE
3) Low pitched rumble
4) Louder in INspiration
5) High-pitched opening snap

Question 16

What are the characteristics of a mitral stenosis murmur?

Answer 16

1) MDM
2) Apex
3) Low pitched rumble
4) High-pitched opening snap

Question 17

What are the causes of continuous heart murmurs?

Answer 17

1) PDA
- L infraclavicular / ULSE

2) R/L BT shunt
- R/L infraclavicular
- R/L lateral thoracotomy or median thoracotomy scar

Question 18

What are the characteristics of a patent ductus arteriosus murmur?

Answer 18

1) Continuous murmur
2) L infraclavicular/ ULSE
3) Bounding pulse

Question 19

What are the characteristics of a BT shunt?

Answer 19

1) Continuous murmur
2) R/L infraclavicular
3) R/L lateral thoracotomy/ median sternotomy
4) Bounding pulse

Question 20

What are 5 differentials for cardiac syncope?

Answer 20

1) Structural heart disease
- LVOTO (aortic stenosis, HOCM)

2) Arrythmia
3) Acquired heart disease (myocarditis)
4) Vasovagal reflex
5) Orthostatic hypotension (drug-induced, postural tachycardia syndrome, volume depletion)

Question 21

What are components of a palpitations history?

Answer 21

1) Freq.
2) Triggers
3) Onset and offset (sudden/ gradual)
4) Duration
5) Associated symptoms
- pre-syncope/ syncope
- SOB
- chest pain

Question 22

What are 5 differentials for palpitations?

Answer 22

1) Primary tachyarrhythmias
2) Drugs, anemia, hyperthyroidism
3) Shock
4) Physiological (anxiety, stress, fear, exercise)
5) Fever

Question 23

What are 5 red flags for chest pain?

Answer 23

1) Exertional
2) A/w palpitations, syncope, dizziness
3) Hx of cardiac surgery
4) Hx of kawasaki disease
5) Hx of CTD (eg. marfans)
6) FHx of SCD or HOCM

Question 24

What 5 cardiac causes of chest pain?

Answer 24

1) Arrhythmias

Structural
2) LVOTO
3) Congenital abnormalities of coronary artery
4) Acquired conditions (eg. kawasaki disease)

Function
5) Myocarditis
6) Cardiomyopathy

Question 25

What are 4 differentials for kawasaki disease?

Answer 25

1) Measles 2) Scarlet fever 3) Infectious mononucleosis 4) Adenovirus

Question 26

What is the diagnostic criteria for kawasaki?

Answer 26

Fever >3days and at least 4/5 of: 1) Change in lips/ oral cavity 2) Changes in extremities - acute: erythema of palms/ soles - subacute: periungual peeling of fingers 3) Polymorphous exanthema (diffuse maculopapular, urticarial, erythroderma, erythema-multiforme) 4) Bilateral bulbar conjunctival injection w/o exudates 5) Cervical lymphadenopathy (>1.5 diameter)

Question 27

How long does clubbing and polycythemia usually take to manifest in children?

Answer 27

1 year

Question 28

How is the severity of a VSD determined?

Answer 28

Complications: - NOT RELATED to volume of murmur - basal creps - apex deviation (LVH)

Question 29

How does squatting help with tet spells?

Answer 29

Squat → ↑intrathoracic pressure → ↑preload → ↑RV pressure → ↑lung perfusion

Question 30

Why do patients with tetralogy of fallot not usually have VSD murmurs?

Answer 30

VSD in TOF usually large and unrestrictive → minimal pressure gradient across ventricles → no murmur