Cardiology Flashcards
1
Q
- Which of the following pulse profiles matches the diagnosis given:
a. pulsus alternans-constrictive pericarditis
b. atrial fibrillation-hypothyroidism
c. pulsus bigeminus-digoxin toxicity
d. dicrotic pulse-mitral stenosis
A
c. pulsus bigeminus-digoxin toxicity
Pulsus Alternans (regular rhythm but varying volume of pulse)
- Myocardial failure (left), aortic stenosis, hypertension, asthma, large pericardial effusion
Pulsus Bigeminus
- Two heartbeats close together followed by longer pause (normal heart beat then a premature beat) -conduction issue
- Causes: HOCM, digoxin toxicity, hypothyroidism, K abnormalities
2
Q
In what conditions do you see pulsus paradoxus?
A
- cardiac tamponade, asthma, constrictive pericarditis, pericardial effusion
3
Q
What are causes of atrial fibrillation?
A
PIRATES Pulmonary Embolus or Pulmonary Disease (COPD) o Ischemia o Rheumatic or Regurgitation (mitral) o Anemia or Atrial Myxoma o Thyrotoxicosis or Toxins o Electrolytes or Ethanol o Sepsis or Stimulants
4
Q
- List 3 causes of cyanotic congenital heart disease with decreased pulmonary blood flow
A
TOF
tricuspid atresia
pulmonary stenosis
5
Q
- A term IDM newborn is seen at 48 hours of age with a grade 3/6 SEM at the LSB. On echo there is
hypertrophy of the septal muscle but no decrease in function. What is the clinical course:
a. Will resolve with no treatment
b. corticosteroids
A
a. Will resolve with no treatment
IDMs have increased risk of transient hypertrophic cardiomyopathy
- associated with inter ventricular septal hypertrophy and decreased ventricle size (increased risk for LVOTO)
- resolves spontaneously as plasma insulin levels normalize (2-3 weeks), usually asymptomatic, may have resp distress
6
Q
- Which of the following are true?
( a) fetal p02 is 25-30
(b) the incidence of asymptomatic PFO in the adult population is 10%
A
( a) fetal p02 is 25-30
*15-25% of adults have asymptomatic PFOs
7
Q
An ECG is shown. Left axis deviation, increased forces, ST-T changes with T-wave inversion.
a) LVH
b) RVH
c) heart block
d) Wolff-Parkinson-White
e) ST-T changes associated with digoxin therapy
A
a) LVH
changes in keeping with LVH:
- depression of ST segments and inversion of T waves in left precordial leads (V5, V6) - left
ventricular strain pattern - suggest presence of a severe lesion
- deep Q wave in left precordial leads
- deep S wave in V1
- tall R wave in V6
8
Q
What are ECG changes in keeping with RVH?
A
- right axis deviation
- *note in first week of life need serial ECGs to determine if there is RVH beyond what is
physiologically normal for a neonate (right ventricular dominance) - tall R waves in V1
- deep S waves in V6
- upright T waves in V1 and V4R
9
Q
Which type of heart block is most concerning for progression to complete heart block?
A
Second degree, type II (mobitz II): no progressive prolongation of PR interval; a P wave is predictably non-conducted in a specific pattern (e.g. every 2 beats, every 3 beats)
10
Q
ECG features of WPW and why do we worry about it?
A
- short PR interval
- slow upstroke of the QRS (delta wave)
- increased risk of a fib leading to v fib and death
- usually the heart is normal, but can be associated with HOCM or Epstein’s anomaly of the tricuspid valve
11
Q
- You are seeing a teenager with a history of recurrent syncopal episodes. What is the best
screening test for prolonged QT syndrome.
a) EKG
b) exercise EKG
c) Holter monitor
d) echocardiogram
e) electrolytes
A
a) EKG
Findings:
- QTc>0.47 seconds is highly indicative, >0.44 is suggestive
- notched T waves in 3 leads
- T-wave alternans (beat to beat variation in amplitude or shape of the T wave)
- low resting heart rate for age
12
Q
What are 2 syndromes associated with long QT?
A
Romano-Ward
Jervell-Lange-Nielsen (associated with congenital SNHL)
13
Q
Romano-Ward and Jervell-Lange-Neilsen are 2 syndromes associated with what?
A
Long QT
14
Q
What are some medications that can cause long QT?
A
- antibiotics: erythro/clarithro/azithro, septra, fluoroquinolones
- TCAs, SSRIs
- antipsychotics: haldol, risperidone, chlorpromazine
- lasix, ondansetron
15
Q
How do you treat long QT syndrome?
A
Beta blockers (to blunt HR response to exercise) - propranolol and nodal used
- may then need pacemaker for drug induced bradycardia
- if still syncopal on beta blockers or have had cardiac arrest, need ICD
16
Q
34. 3 day infant cyanosis with crying, investigation a ECG b CXR c ABG d bld cx e echo
A
e echo
Worry about cyanotic heart disease, especially TOF given cyanosis with crying
17
Q
- Kid with down’s syndrome and previous CHD repair, now many years later going for
surgery. List 2 considerations
A
- potential C spine instability (atlanto-axial)
- upper airway obstruction (hypotonia)
- current cardiac condition and need for endocarditis prophylaxis
- risk of pulmonary hypertension
- risk of heme abnormalities
- suggested screening: ECG, echo, CBC
18
Q
- Management of hypercholesterolemia (+Fhx)
A
Fam Hx includes MI/stroke before age 55, CAD, peripheral vascular disease, coronary intervention, parent with hyperlipidemia (>6.2 - 99% of people with LDL >6.2 have FH)
- evaluate for secondary causes: obesity, hyper/hypothyroid, hypercortisol, diabetes, biliary cirrhosis, nephrotic syndrome, meds (cyclosporine, estrogen, isotretinoin (accutane))
- diet and lifestyle modifications:
- all kids over 2 should follow step 1 diet (<10% calories from sat fat, <30% calories from fat, <300mg/day cholesterol)
- if patient’s fasting LDL is high, should switch to step 2 diet (<7% calories from sat fat, <200mg cholesterol)
- refer to dietician for assistance
- 60 minutes of mod-vigorous activity daily
- re-evaluate in 6 months and if still high then start statin - medication therapy: statins, bile acid resins
19
Q
- Newborn diagnosed with interrupted aortic arch, what to start?
a. dopamine
b. prostaglandin
c. nitric oxide
d. indomethacin
A
b. prostaglandin
20
Q
- Name 4 side effects of prostaglandin E.
A
Hypotension apnea fever edema pyloric stenosis
21
Q
Neonate with PDA treated with indocid. List
four side effects of indocid
A
Indocid= Indomethacin ● Decreased platelet function: GI bleed, IVH ● NEC ● Transient renal insufficiency ● Spontaneous GI perforation
22
Q
- 6 wk old with pansystolic murmur, increasing respiratory distress and liver edge down.
CXR shows increased pulmonary markings. Which medication would you consider to
help his symptoms?
a. propanolol
b. furosemide
c. digoxin
d. adenosine
A
b. furosemide
23
Q
- Newborn baby with cyanotic congenital heart disease. Most consistent physical exam finding:
a) bounding/dynamic precordium
b) normal pulses and quiet precordium
c) decreased pulses and poor perfusion
d) tachypnea and nasal flaring
e) palpable thrill
A
b) normal pulses and quiet precordium
o Cyanosis- most have no murmur and no distress
▪ TGA, pulm or tricuspid atresia
24
Q
- A 3 day old is tachypneic, cyanosed despite 100% O2. Bilateral crackles on exam with weak peripheral pulses and no heart murmur. What is the diagnosis:
a) HLHS
b) Sepsis
c) AV fistula
A
a) HLHS
Most are acutely ill within first days/weeks of life (as PDA closes) o Lactic acidosis o HF o Cardiogenic shock o Cyanosis o Poor pulses o Hyperdynamic cardiac impulse
Mgmt: start PGE, surgical palliation (Norwood, Glenn, Fontan) or transplant
25
3. Child with supravalvular aortic stenosis, prominent lips, developmental delay, and hypercalcemia. This is indicative of:
1. DiGeorge
2. Williams
3. Noonans
4. Downs
5. Fetal alcohol syndrome
2. Williams
o Narrowing above level of coronary arteries
o Systolic murmur at base and toward neck
o May have higher BP in right arm than left (because of direction of blood flow) aka Coanda effect
26
What congenital cardiac defect is associated with Williams syndrome?
supravalvular aortic stenosis
Other features:
▪ ID, cocktail party personality, elf-like facies,hypercalcemia
▪ Narrowing of peripheral systemic and pulmonary arteries (may have hypertension)
27
14. 15 y o boy for regular check up and exam shows Ht > 95 th , Wt 50%, arm span > ht, +
pectus, flat feet. What is the most likely cardiac defect that could be found.
a. Mitral valve prolapse
b. Bicuspid Ao valve
c. Dilatation Ascending aorta
d. VSD
Dilatation of aortic root
Dissection of ascending aorta
Also (involvement, not major criteria): mitral valve prolapse
c. Dilatation Ascending aorta
a. Mitral valve prolapse
* either could be correct
28
What is the revised Ghent criteria for Marfan if no family history?
1. Aortic root dilatation z score 2+ or dissection AND ectopia lentis = diagnosis of Marfan
2. Aortic root dilatation z score 2+ or dissection AND FBN1 mutation = diagnosis of Marfan
3. Ectopia lentia AND FBN1 mutation that is associated with aortic disease = diagnosis of Marfan
4. Aortic root dilatation z score 2+ or dissection AND systemic score of 7+ points = diagnosis
29
What is the revised Ghent criteria for Marfan if positive family history?
1. Ectopia lentis + family history = Marfan diagnosis
2. Systemic score of 7+ AND family histroy = Marfan
3. Aortic root dilatation z score 3+ (for ppl under age 20) AND family history = Marfan
30
What are the components of the systemic score in Ghent criteria when evaluating for Marfan syndrome?
Wrist and thumb sign
Pectus carinatum/excavatum/chest asymmetry
Hindfoot deformity
Plain flat foot
Spontaneous pneumothorax
Dural ectasia (widening of sac around spinal cord)
Protrucio acetabluae (displacement of acetabulum and femoral head)
Scoliosis, thoracolumbar kyphosis
Reduced elbow extension
Skin striae
Myopia
Mitral valve prolapse
Reduced upper:lower segment or increased arm span:height
3/5 facial features: dolicocephaly, downward slanting palpebral fissures, enopthalmus, retrognathia, malar hypoplasia
31
A newborn baby has tachypnea and cyanosis. With 100% O2 the O2sat improves from 80% to 85%.
On CXR the pulmonary vasculature is normal and there are no other abnormalities noted. Which
lesion is this most consistent with:
a. HLHS
b. TOF
c. Tricuspid atresia
d. TGA
c. Tricuspid atresia - decreased pulmonary vascular markings, no other CXR findings
HLHS - increased pulmonary vascular markings, pulmonary edema
TOF - decreased pulmonary vascular markings, boot shaped heart, 25% right aortic arch
TGA - increased pulmonary vascular markings, egg shaped heart
32
3-day-old infant with congenital heart disease whose cyanosis is aggravated by crying. Most likely from choice? Most likely not included in these choices?:
a) TGA
b) VSD
c) ASD
d) PDA
e) PS
e) PS
Per Dr. Wong this is most likely actually describing TOF, but given the choices PS is the most correct
33
Patients with ASDs have a fixed split S2. This is due to:
a) pulmonary hypertension
b) abnormal pulmonary valve
c) pooling of blood in the pulmonary vasculature
d) late eruption of the right atrium
e) prolonged right ventricle ejection
e) prolonged right ventricle ejection
- mild left precordial bulge on examination of chest wall
- right ventricular systolic lift at left sternal border
- pulmonic ejection click may be heard
- classic finding is fixed split S2 during all phases of respiration
- systolic ejection murmur, medium pitch, harsh, at left middle and LUSB (produced by increased flow
through right ventricular outflow tract, NOT by flow through the actual ASD)
- potential rumbling mid diastolic murmur at LLSB produced by increased flow of blood across tricuspid
valve (best heard with bell)
34
Infant with large VSD. The murmur cannot be heard. What is the cause?
a) VSD has closed
b) there is increased pulmonary outflow obstruction
c) pulmonary arterial pressures have increased
c) pulmonary arterial pressures have increased - known complication of unrepaired VSD
VSD has closed - large VSD unlikely to close spontaneously
There is increased pulmonary outflow obstruction - possible but occurs infrequently
35
What is the most common physical examination finding in congenital cyanotic heart disease?
Most often asymptomatic.
36
Newborn with meconium stained fluid, needed resuscitation, poor apgars. Cyanotic and in 100% O2 had a PO2 of 70 with a normal CO2 (Rt Radial A) . Cord gas had O2 of 30. CXR normal sized heart and decreased vascularity. Most likely diagnosis
a) PPHN
b) TGA
c) TAPVD
d) Mec aspiration syndrome
a) PPHN (BW implied that pre sat higher than post)
Why others are wrong:
b) TGA (increased vascularity)
c) TAPVD (increased vascularity)
d) Mec aspiration syndrome (cyanosis improve with oxygen if no PPHN)
37
What are secondary causes of PPHN?
```
Abnormal pulmonary vascular development (pul resistance up)
- Chronic fetal hypoxia/Asphyxia
- Maternal DM
- Alveolar Capillary Dysplasia
Pulmonary Hypoplasia:
- Congenital Diaphragmatic Hernia
- Potter’s Syndrome
- Prolonged Oligohydraminos
- Renal agenesis
Post-natal elevation in pul vasoconstrictors
- Sepsis
- Pneumonia
- MAS
- Perinatal Asphyxia
```
38
Long term complications of PPHN?
hearing loss, developmental delay, intellectual disability
39
Cyanotic baby, presents at 5 days of age. His sats increase from 79 to 81 with oxygen. His RR – 50s, HR 180s. On exam he has single S2 loud, no murmur. Chest X-ray shows narrow mediastinum and mildly increased pulmonary markings. EKG shows mild right ventricular hypertrophy. What is your diagnosis? What is one medication you can give for treatment? What are four complications of this treatment.
Diagnosis: TGA (Single S2, no murmur because no turbulence, cyanotic)
Mgmt: Prostaglandin E1
Complications: apnea, hypotension, pyloric stenosis, fever, edema
40
8. What is most characteristic of a Still’s murmur:
a. vibratory murmur
b. increases with sitting
c. often radiates to axilla
a. vibratory murmur
Louder when lying
LLSB toward apex
41
What are the features of a venous hum on physical exam?
– Whining, roaring, whirring Gr 1-6, continuous, systolic/diastolic murmur (3-8y)
– Supra/infraclavicular (R>L)
– Sitting or standing (disappears when supine or applied pressure to jugular vein, or with rotation of head)
– Caused by blood cascading down jugular vein, louder in diastole as atrium empties
– DDx PDA
42
1. A 3 year old child is referred to your office after a murmur is picked up by the family doctor on
routine physical examination. You hear a harsh continuous murmur in the right infraclavicular
area that is loudest when sitting and disappears on lying flat. The remainder of her cardiac exam
is within normal limits. What is this most consistent with:
a. PDA
b. Venous hum
c. Still’s murmur
b. Venous hum
43
A 12 month old child is seen in your ED with a cough and fever. A RLL consolidation is seen on
CXR. On examination of the heart, you hear a loud S1, a fixed split S2 and a SEM over the LUSB.
What is the cause of the child’s heart murmur:
a. Increased flow secondary to the pneumonia
b. PS
c. ASD
d. Still’s murmur
c. ASD
44
An infant is referred for evaluation of a heart murmur heard on day 2 of life. Birth history is unremarkable. Feeding well. Good colour and perfusion with RR 50. Grade II/VI systolic murmur heard at the left sternal border. Your plan:
a) send back to family doctor with no follow-up
b) follow closely
c) cardiology consult
d) urgent echocardiogram
e) start prostaglandin infusion
b) follow closely
- most likely pulmonary flow murmur of newborn
- systolic murmur (early to mid systolic)
- loudest at LUSB, with radiation to axilla and back
- grade 1-2/6
- blowing quality
- usually disappears by 1-2 months
45
3/6 systolic murmur with ejection click in left upper sternal border. Quiet S2. Kid is 3y/o.
a. PS
b. PDA
c. TET
d. Coarctation
a. PS
Pulmonary Stenosis: high pitched high grade murmur over pulmonic, radiate to L carotid, widely split S2 with decreased P2 +/- ejection click
Tetralogy of Fallot: Single S2, harsh systolic ejection murmur of PS.
PDA: continuous machine like murmur
46
Teen is at a concert and feels dizzy and then passes out briefly. You suspect that this is vasovagal syncope. List 4 signs and symptoms that would make you suspicious for a cardiac origin of syncope.
1. Syncope mid exertion
2. Syncope in the context of a family history of sudden death
3. Syncope without a prodrome
4. Abnormal Cardiac exam
5. History of heart disease
6. New medication with potential cardiotoxicity
47
7 y with viral URTI 2 weeks ago. Now presents in CHF and a maculopapular rash. What is the most likely diagnosis?
a. Viral myocarditis
b. Acute rheumatic fever
c. Subacute bacterial endocarditis
a. Viral myocarditis
- DDx
o Infectious
▪ Viral most common
● Coxsackie, Parvovirus, other entero/adeno, EBV, CMV, influenza
● Present with heart failure or chest pain
o Immune
o Toxic
48
List 4 other signs of endocarditis in a child with a fever, murmur, tachycardia and hepatospenomegaly.
```
Embolic findings:
- Roth spots (hemorrhage in retina)
- petechiae
- splinter hemorrhages
- Osler nodes
- Janeway lesions
Arthritis
Heart failure
Clubbing
Arrhythmias
Hematuria
```
49
When is endocarditis prophylaxis indicated?
When undergoing a dental procedure which manipulates the gums or perforates the oral mucosa, incision or biopsy of resp mucosa (tonsillectomy or adenoidectomy, bronch with biopsy), never for GI/GU procedures:
- prosthetic cardiac valve
- previous IE
- unprepared cyanotic congenital heart disease (including partially repaired like palliative shunts)
- completely repaired CHD with prosthetic material or device within 6 months of surgery
- repaired CHD with residual defects adjacent to prosthetic material
- heart transplant recipients with valvulopathy
- rheumatic heart disease if prosthetic valve or material used in repair
50
List 5 diagnostic criteria for Kawasaki disease.
```
5 days of fever
bilateral non purulent conjunctivitis
lymphadenopathy >1.5cm
swelling/redness of hands or feet
mucosal involvement (strawberry tongue, cracked red lips, pharyngitis)
rash (not vesicular, bullous, petechial)
```
51
4 week in obvious CHF. Huge voltages on EKG, short pr interval. Hypotonic and progressive weakness. Hepatosplenomegaly and large tongue. What does this child have?
Pompe Disease
- Example of inherited form of hypertrophic cardiomyopathy
- Type 2 glycogen storage disease
Treat with enzyme replacement
52
Meds with prolonged QT
e. Hypercalcemia
f. Hypokalemia
g. Clarithromycin
h. Digoxin
f. Hypokalemia
g. Clarithromycin
Both can prolong QT; also HYPOcalcemia, hypoMg, TCAs, anti-arrhythmics (procainamide, amiodarone, sotalol)
53
An 11 month old child with PEA. What to give:
1. Epi 1cc of 1:1000 IV
2. Epi 1cc of 1:10000 IV
3. Atropine
4. Amiodarone
2. Epi 1cc of 1:10000 IV (0.1ml/kg)
54
Picture of narrow complex tachycardia, no palpable pulse with poor perfusion:
a. Carotid massage
b. Asynchronous cardioversion
c. Adenosine
d. Verapamil
b. Asynchronous cardioversion - no pulse means you're on the cardiac arrest algorithm
SVT with poor perfusion - go right to cardioversion as opposed to adenosine
55
An infant is in shock with paroxysmal supraventricular tachycardia. You would give:
a) bag of ice to face
b) synchronous DC cardioversion
c) asynchronous cardioversion
d) verapamil
e) digoxin
b) synchronous DC cardioversion (assuming there is a pulse)
56
Neonatal goiter. What anti-arrhythmic was mom on?
a. Digoxin
b. Procainimide
c. Amiodarone
d. Sotalol
c. Amiodarone
Congenital goitre: Fetal T4 defect or maternal antithyroid drugs/ iodides - mom and baby have hypothyroid
● Amiodarone (37% iodine content) can also cause congenital goiter with hypothyroidism
57
First line treatment of a child with pulseless Ventricular tachycardia.
Defibrillate (unsynchronized) with 2J/kg
58
First line treatment of a child with asystole:
epinephrine (PEA or asystole - not a shockable rhythm)
59
First line treatment of a child with bradycardia
epinephrine, then atropine
60
First line treatment of a child with SVT
adenosine
61
First line treatment of a child with V tach with pulse
amiodarone
62
First line treatment of a child with V tach without a pulse
epinephrine, the amiodarone or lidocaine (same as V fib)
63
2 year old with signs of CHF. EKG looks like SVT. Give 3 things that would suggest SVT on EKG
1. HR >200
2. Absent or abnormal p waves (abnormal axis)→ “absent” more common in neonates
3. Unvarying rate
Also: narrow QRS
64
An infant is irritable and is feeding poorly. Your EKG looks something like this (but much faster! - SVT): The child is stable . What are TWO things that you would do for management?
1. Vagal manuvers (ice, valsalva, breath holding)
| 2. Adenosine *remember adenosine can cause a fib so be ready for DC cardioversion
65
Name 3 EKG finding of Hyperkalemia. Name 3 ways to treat hyperkalemia
```
Three findings on ECG:
1. Tall peaked T waves
2. Prolonged PR
3. Wide QRS
4. Flattened/absent p waves
Progresses to v fib or asystole
```
Mgmt:
1. Calcium gluconate 10% solution, 1ml/kg IV over 3-5mins
2. NaHCO3 1-2mEq/kg IV over 5-10 mins
3. regular insulin 0.1U/kg with 50% glucose solution 1ml/kg over 1 hour
4. Ventolin (5mg neb)
5. Kayexalate
6. Consider if dialysis needed
66
Newborn with persistent bradycardia. ECG given. Looks like heart block... identify the problem. What 2 things is this child at risk for?
Congenital heart block usually secondary to maternal autoimmune disease (i.e. SLE, Sjogren's RA). At risk for:
1. Cytopenias → anemia, leukopenia (less TCP)
2. Light sensitive annular or macular rash
3. Hepatitis
67
A 3 week old infant presents with 3 days of progressive difficulty feeding, vomiting and tachypnea. On examination his HR is 260, BP is 80/50, CR is 3s and the liver is 5 cm below the costal margin. What is the most likely etiology:
a. SVT
b. Myocarditis
c. VSD
a. SVT
68
SVT in neonates is most commonly associated with:
a) hypocalcemia
b) hyperthyroidism
c) electrolyte disturbances
d) ventricular septal defect
e) structurally normal heart
e) structurally normal heart
69
Concerning complete AV block, all are true EXCEPT:
a) may be a cause of syncopal episodes
b) ventricular rate of 30-60 bt/min
c) if you hear a systolic murmur then it is associated with a congenital heart lesion
d) diagnosis is confirmed by ECG
e) may be present in infants born to mothers with SLE
c) if you hear a systolic murmur then it is associated with a congenital heart lesion
70
Neonate with complete heart block. ECHO normal. List 2 causes.
o Maternal SLE
o Maternal Sjogren Syndrome
Structural associations if echo was not normal:
ASD (mutation in homeobox gene described w/ ASD lesions)
o Post VSD closure complication
o Abnormal development of conduction system
o Myocardial Tumour
o Myocarditis
o Complication of myocardial abscess secondary to endocarditis
71
A full term infant is diagnosed with meconium aspiration syndrome. He is desaturating despite 100% oxygen. An echocardiogram shows normal cardiac anatomy and R to L shunting at the ductus and atrial level. Which of the following interventions may be effective:
a. dopamine
b. indomethacin
c. nitric oxide
d. prostaglandins
c. nitric oxide
72
Two heart lesions with a single S2.
1. TGA or transposition or malposition of the great arteries
| 2. Pulmonary atresia
73
What is the most common cyanotic cardiac disease in the newborn period?
TGA
● Cyanosis is apparent within the first few hours of life and is not responsive to oxygen.
CXR: egg on a string
74
Initial management of an infant with suspected TGA?
Start PGE1 - may need balloon atrial septostomy if not responding
75
Child with cyanosis, O2 sat 80% doesn’t improve with oxygen. Pansystolic murmur grade III/VI. CXR normal and ECG shows right axis deviation. What is the diagnosis?
TOF
- pansystolic murmur is probably from VSD
- do see RAD on ECG
76
A teenager is seen in the ER with shortness of breath. He has distended neck veins,hepatomegaly and an S3 and an S4. What are TWO abnormalities on this CXR?
(Cardiomegaly and a left sided pleural effusion). What are TWO possible diagnoses?
Findings on CXR in right sided heart failure
1. Cardiomegaly
2. Prominence of the pulmonary veins in the hilar region
3. Enlarged right atrium & ventricle
4. Loss of pulmonary vasculature in the periphery
5. Pleural effusion
DDx - likely acquired in a teen:
1. myocarditis
2. cardiomyopathy (hypertrophic or dilated)
3. infective endocarditis (acquired valve disease)
- acute HTN (glomerulonephritis)
- thyrotoxicosis
- sickle cell anemia
77
A 2-day-old infant presents in congestive heart failure. He has hydrocephalus. He has a seizure 1 hour after admission. Most likely cause:
a) vein of Galen aneurysm
b) intraventricular hemorrhage
c) hypoxic ischemic encephalopathy
d) cerebral abscess
e) meningitis
a) vein of Galen aneurysm
AVMs are most common cause of hemorrhagic stroke in children
O/E: continuous murmur when listen over fontanelle
Basically there is no capillary bed separating arteries from vein, so the blood flows really quickly and easily from the artery into the venous system. The heart has to pump harder and faster to increase CO to keep up with this much faster flow of blood through the brain. The baby then develops high output cardiac failure
78
Which of the following is associated with an increased risk of necrotizing fasciitis?
a) parvo virus
b) roseola
c) Kawasaki disease
d) varicella
e) rosacea
d) varicella
Varicella is a risk factor for group A strep infection which causes neck fasc
```
Other risk factors:
diabetes
HIV
IVDU
chronic pulmonary or cardiac disease
```
79
A 14 year old boy was found unresponsive in a park the morning after the overnight temperature dropped to -3°C. He has been receiving resuscitation in the ER for 30
minutes. Which of the following would be an indication to stop the resuscitation?
a. Rectal temperature of 30°C
b. Barbiturates found on toxicology screen
c. Refractory ventricular fibrillation
d. Electromechanical dissociation / PEA
d. Electromechanical dissociation / PEA
Temp - needs to be warmed up
Drugs - need to wait for effects to wear off or reverse if toxins are an explanation
80
4 risk factors for atherosclerosis.
1. Hypertension
2. Obesity
3. Diabetes
4. Family history of premature coronary artery disease
5. Smoking
